中国临床保健杂志
中國臨床保健雜誌
중국림상보건잡지
CHINESE JOURNAL OF CLINICAL HEALTHCARE
2015年
3期
274-278
,共5页
刘铭%唐海沁%张亚文%张勇
劉銘%唐海沁%張亞文%張勇
류명%당해심%장아문%장용
冠状动脉疾病%血小板聚集抑制剂%Meta 分析
冠狀動脈疾病%血小闆聚集抑製劑%Meta 分析
관상동맥질병%혈소판취집억제제%Meta 분석
Coronary%Platelet aggregation inhibitors%Meta-analysis
目的系统评价替格瑞洛抗血小板治疗急性冠脉综合征(ACS)患者的有效性和安全性。方法应用计算机检索 PubMed、Embase、Cochrane 图书馆临床对照试验数据库(CCRCT)、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(CNKI)、维普数据库(VIP)、万方医学数据库,检索时限为建库至2014年8月,收集替格瑞洛治疗 ACS 实验。两名评价员独立评价文献质量和提取资料,并采用 RevMan 5.0软件对资料进行 Meta 分析。结果共纳入8个研究,19875例患者。(1)替格瑞洛与氯吡格雷抗血小板治疗相比,能够降低心血管原因死亡发生率(OR =0.79,95%CI 为0.69~0.91,P <0.01),在进行侵入性治疗时,替格瑞洛亦优于氯吡格雷(OR =0.80,95%CI 为0.67~0.96,P <0.05)。(2)替格瑞洛可显著降低再发心肌梗死事件发生率(OR =0.83,95%C1为0.74~0.94,P <0.01),在进行侵入性治疗时,替格瑞洛显著优于氯吡格雷(OR =0.78,95%CI 为0.68~0.91,P <0.01)。(3)替格瑞洛与氯吡格雷治疗比较,可降低 MACE 事件发生率(OR =0.83,95%CI 为0.76~0.91,P <0.01),在进行侵入性治疗时,替格瑞洛亦优于氯吡格雷(OR =0.82,95%CI 为0.73~0.92,P <0.01)。(4)在出血并发症方面,替格瑞洛抗血小板治疗与氯吡格雷相比,差异无统计学意义(OR =1.03,95%CI 为0.94~1.13,P >0.05),在侵入性治疗亚组中,也差异无统计学意义(OR =0.99,95%CI 为0.89~1.11,P >0.05)。结论替格瑞洛可降低 ACS 患者的心血管死亡、再发心肌梗死及死亡、再发心肌梗死或卒中的复合终点事件发生率,且未增加出血风险。
目的繫統評價替格瑞洛抗血小闆治療急性冠脈綜閤徵(ACS)患者的有效性和安全性。方法應用計算機檢索 PubMed、Embase、Cochrane 圖書館臨床對照試驗數據庫(CCRCT)、中國生物醫學文獻數據庫(CBM)、中文科技期刊全文數據庫(CNKI)、維普數據庫(VIP)、萬方醫學數據庫,檢索時限為建庫至2014年8月,收集替格瑞洛治療 ACS 實驗。兩名評價員獨立評價文獻質量和提取資料,併採用 RevMan 5.0軟件對資料進行 Meta 分析。結果共納入8箇研究,19875例患者。(1)替格瑞洛與氯吡格雷抗血小闆治療相比,能夠降低心血管原因死亡髮生率(OR =0.79,95%CI 為0.69~0.91,P <0.01),在進行侵入性治療時,替格瑞洛亦優于氯吡格雷(OR =0.80,95%CI 為0.67~0.96,P <0.05)。(2)替格瑞洛可顯著降低再髮心肌梗死事件髮生率(OR =0.83,95%C1為0.74~0.94,P <0.01),在進行侵入性治療時,替格瑞洛顯著優于氯吡格雷(OR =0.78,95%CI 為0.68~0.91,P <0.01)。(3)替格瑞洛與氯吡格雷治療比較,可降低 MACE 事件髮生率(OR =0.83,95%CI 為0.76~0.91,P <0.01),在進行侵入性治療時,替格瑞洛亦優于氯吡格雷(OR =0.82,95%CI 為0.73~0.92,P <0.01)。(4)在齣血併髮癥方麵,替格瑞洛抗血小闆治療與氯吡格雷相比,差異無統計學意義(OR =1.03,95%CI 為0.94~1.13,P >0.05),在侵入性治療亞組中,也差異無統計學意義(OR =0.99,95%CI 為0.89~1.11,P >0.05)。結論替格瑞洛可降低 ACS 患者的心血管死亡、再髮心肌梗死及死亡、再髮心肌梗死或卒中的複閤終點事件髮生率,且未增加齣血風險。
목적계통평개체격서락항혈소판치료급성관맥종합정(ACS)환자적유효성화안전성。방법응용계산궤검색 PubMed、Embase、Cochrane 도서관림상대조시험수거고(CCRCT)、중국생물의학문헌수거고(CBM)、중문과기기간전문수거고(CNKI)、유보수거고(VIP)、만방의학수거고,검색시한위건고지2014년8월,수집체격서락치료 ACS 실험。량명평개원독립평개문헌질량화제취자료,병채용 RevMan 5.0연건대자료진행 Meta 분석。결과공납입8개연구,19875례환자。(1)체격서락여록필격뢰항혈소판치료상비,능구강저심혈관원인사망발생솔(OR =0.79,95%CI 위0.69~0.91,P <0.01),재진행침입성치료시,체격서락역우우록필격뢰(OR =0.80,95%CI 위0.67~0.96,P <0.05)。(2)체격서락가현저강저재발심기경사사건발생솔(OR =0.83,95%C1위0.74~0.94,P <0.01),재진행침입성치료시,체격서락현저우우록필격뢰(OR =0.78,95%CI 위0.68~0.91,P <0.01)。(3)체격서락여록필격뢰치료비교,가강저 MACE 사건발생솔(OR =0.83,95%CI 위0.76~0.91,P <0.01),재진행침입성치료시,체격서락역우우록필격뢰(OR =0.82,95%CI 위0.73~0.92,P <0.01)。(4)재출혈병발증방면,체격서락항혈소판치료여록필격뢰상비,차이무통계학의의(OR =1.03,95%CI 위0.94~1.13,P >0.05),재침입성치료아조중,야차이무통계학의의(OR =0.99,95%CI 위0.89~1.11,P >0.05)。결론체격서락가강저 ACS 환자적심혈관사망、재발심기경사급사망、재발심기경사혹졸중적복합종점사건발생솔,차미증가출혈풍험。
Objective To systematically evaluate the efficacy and safety of ticagrelor on antiplatelet therapy in acute coronary syndrome (ACS)patients.Method The randomized controlled trials (RCTs)on ticagrelor versus clo-pidogrel for ACS in the PubMed,Embase,CCRCT,CBM,CNKI,VIP,WangFang Date from the date of their establish-ment to August 2014 were collected.According to the inclusion and exclusion criteria,two reviewers independently screened the studies and evaluate the quality of the iterature,using RevMan 5.0 software for data Meta-analysis.Results A total of 8 studies 19875 patients were included.The results showed that ticagrelor can effective improve the progno-sis of ACS patients:(1)Ticagrelor can reduced the mortality of cardiovascular causes (OR =0.79,95%CI of 0.69 ~0.91,P <0.01),and ticagrelor was superior to clopidogrel during invasive treatment(OR =0.80,95%CI of 0.67 ~0.96,P <0.05).(2)Ticagrelor reduced the incidence of myocardial infarction events (OR =0.83,95%CI 0.74 ~0.94,P <0.01),during invasive treatment,ticagrelor was significantly better than clopidogrel (OR =0.78,95%CI of 0.68 ~0.91,P <0.01).(3)Ticagrelor reduced the incidence of MACE events (OR =0.83,95%CI of 0.76 ~0.91,P<0.01),during invasive treatment,ticagrelor also was superior to clopidogrel (OR =0.82,95%CI of 0.73 ~0.92,P <0.01).(4)In the complications of bleeding,ticagrelor was not different from clopidogrel (OR =1.03,95%CI of 0.94~1.13,P >0.05),and no statistically significant difference was found in invasive Asian group(OR =0.99,95%CI of 0.89 ~1.11,P >0.05).Conclusion Ticagrelor can reduce cardiovascular death,recurrent myocardial infarction and the composite end point of death,recurrent myocardial infarction,stoke in patients with ACS,and does not increase the risk of bleeding.