西罗莫司洗脱支架与紫杉醇洗脱支架在糖尿病合并冠心病患者中运用的Meta分析

摘要

Objective To assess the efficacy and safety of sirolimus-eluting stent( SES )and paclitaxel-eluting stent( PES )in Diabetic Patients with Coronary Artery Disease. Methods We searched Cochrane Controlled Register Trials, Pubmed, Embase, Medline, Google scholar databases, CNKI, Wang Fang and VIP databases up to July 2012 to identify studies on SES versus PES in Diabetic Patients with Coronary Artery Disease,The Cochrane Collaboration s software RevMan 5. 1 was used for Meta-analysis. Results No significant heterogeneity was seen across the 8 randomized trials for all analyzed events. Sirolimus-eluting stent was associated with a significant reduction in the risk of TLR( OR:0. 53,95% CI:0.38 ～0.74,P = 0.0002 )and TVR( OR:0. 70,95% CI:0. 50 ～0. 98 ,P = 0. 04 ). No significant differences were observed regarding the risk of death( OR:0. 95 ,95% CI:0. 59 ～ 1. 54,P =0. 84 ) ,myocardial infarction( OR:0. 79,95% CI:0.46～1.38,P = 0. 41 )and stent thrombosis( OR:0. 91,95% CI:0. 46 ～ 1. 82,P =0. 79 ). Conclusions In diabetic patients with coronary artery disease, SES leads a reduction in the risk of TLR and TVR compared with PES. But there is no differences in the risk of stent thrombosis, death and myocardial infarction.%目的 比较西罗莫司洗脱支架(Sirolimus-Eluting Stent,SES)和紫杉醇洗脱支架(Paclitaxel-Eluting Stent,PES)在糖尿病合并冠心病患者中运用的有效性和安全性.方法 选取在2012年7月之前发表的关于比较西罗莫司洗脱支架和在紫杉醇洗脱支架在糖尿病合并冠心病患者中运用的临床随机对照试验研究(RCT),并应用Meta分析方法评估靶病变血运重建率,靶血管血运重建率,支架内血栓形成率等相关指标.结果 共纳入8篇文献包括1680名患者,其中851名患者接受西罗莫司洗脱支架,829名患者接受紫杉醇洗脱支架.Meta分析结果显示,SES组在靶病变血运重建(Target Lesion Revascularization,TLR)率(OR:0.53,95%CI:0.38～0.74,P=0.000 2)和靶血管血运重建(Target Vessel Revascularization,TVR)率(OR:0.70,95%CI:0.50～0.98,P=0.04)方面优于PES组,但在支架内血栓形成率(OR:0.91,95%CI:0.46～1.82,P=0.79)、死亡率(OR:0.95,95%CI:0.59～1.54,P=0.84)、心肌梗死率(OR:0.79,95%CI:0.46～1.38,P=0.41)方面两者无统计学差异.结论 西罗莫司洗脱支架和紫杉醇洗脱支架在术后支架内血栓形成率、死亡率、心肌梗死率方面效果相当,但西罗莫司洗脱支架在降低靶病变血运重建率和靶血管血运重建率方面优于紫杉醇洗脱支架.