CAJ | 학술논문

目的：比较替格瑞洛与氯吡格雷治疗急性冠脉综合征（ACS）的疗效与安全性。方法计算机检索PubMed、Cochrane Central Register of Controlled Trials、CNKI全文数据库，收集2007年1月至2014年4月公开发表的有关替格瑞洛与氯吡格雷治疗急性冠脉综合征疗效和安全性比较的随机对照试验（RCTs），同时辅以手检纳入文献的参考文献。对文献质量进行严格评价后，符合要求的RCTs进行资料提取，采用RevMen5.1软件进行Meta分析。结果共纳入6项RCTs，Meta分析显示：替格瑞洛组与氯吡格雷组之间的主要心脏不良事件（MACE）发生率（OR=0.67，95%CI：0.40～1.11，P=0.12）、心肌梗死发生率（OR=0.92，95%CI：0.81～1.04，P=0.17）、卒中发生率（OR=1.15，95%CI：0.89～1.49， P=0.28）、出血发生率（OR=1.05，95%CI：0.96～1.15，P=0.31）均无统计学差异，但呼吸困难发生率（OR=1.87，95%CI：1.70～2.06，P＜0.00001）有统计学差异。结论在ACS的治疗中，替格瑞洛虽然在呼吸困难发生率上显著高于氯吡格雷，但在MACE、心肌梗死、卒中、出血发生率中与氯吡格雷相似。替格瑞洛具有替代氯吡格雷的潜力，特别是对于不能耐受氯吡格雷和有氯吡格雷抵抗的患者。
목적：비교체격서락여록필격뢰치료급성관맥종합정（ACS）적료효여안전성。방법계산궤검색PubMed、Cochrane Central Register of Controlled Trials、CNKI전문수거고，수집2007년1월지2014년4월공개발표적유관체격서락여록필격뢰치료급성관맥종합정료효화안전성비교적수궤대조시험（RCTs），동시보이수검납입문헌적삼고문헌。대문헌질량진행엄격평개후，부합요구적RCTs진행자료제취，채용RevMen5.1연건진행Meta분석。결과공납입6항RCTs，Meta분석현시：체격서락조여록필격뢰조지간적주요심장불량사건（MACE）발생솔（OR=0.67，95%CI：0.40～1.11，P=0.12）、심기경사발생솔（OR=0.92，95%CI：0.81～1.04，P=0.17）、졸중발생솔（OR=1.15，95%CI：0.89～1.49， P=0.28）、출혈발생솔（OR=1.05，95%CI：0.96～1.15，P=0.31）균무통계학차이，단호흡곤난발생솔（OR=1.87，95%CI：1.70～2.06，P＜0.00001）유통계학차이。결론재ACS적치료중，체격서락수연재호흡곤난발생솔상현저고우록필격뢰，단재MACE、심기경사、졸중、출혈발생솔중여록필격뢰상사。체격서락구유체대록필격뢰적잠력，특별시대우불능내수록필격뢰화유록필격뢰저항적환자。
Objective To compare the curative effect and safety of ticagrelor and clopidogrel in treatment of acute coronary syndrome (ACS). Methods The databases of PubMed, CENTRAL and CNKI were retrieved with computer for collecting the RCT about comparison in curative effect and safety of ticagrelor and clopidogrel in treatment of ACS supplemented manually for searching reference from Jan. 2007 to Apr. 2014. After rigorous reviewing on quality, the data was extracted from eligible RCT and given a Meta-analysis by using RevMen5.1 software. Results There were totally 6 RCT included. The results of Meta-analysis showed that there was no statistical difference between ticagrelor and clopidogrel in the incidence of MACE (OR=0.67, 95%CI:0.40-1.11, P=0.12), myocardial infarction (OR=0.92, 95%CI: 0.81-1.04, P=0.17), stoke (OR=1.15, 95%CI: 0.89- 1.49, P=0.28) and bleeding (OR=1.05, 95%CI:0.96-1.15, P=0.31), but there was statistical difference in the incidence of dyspnea (OR=1.87, 95%CI:1.70-2.06, P<0.00001). Conclusion In ACS treatment, the incidence of dyspnea is higher when administrating ticagrelor, but incidence of MACE, myocardial infarction, stoke and bleeding were similar when administrating ticagrelor or clopidogrel. Clopidogrel may be substituted by ticagrelor, especially in the patients with clopidogrel intolerance or resistance.