替卡格雷与氯吡格雷治疗急性冠脉综合征安全性的系统评价

摘要

目的 系统评价血小板抑制剂替卡格雷与氯吡格雷治疗急性冠脉综合征(ACS)对心血管事件发生率的差异,为心血管事件层面ACS血小板抑制剂的选择提供一定参考.方法 计算机检索中国知网(CNKI)、重庆维普(VIP)、Taylor&Francis平台、万方、Cochrane图书馆、SinoMed、EMbase、PubMed数据库2000年1月-2017年5月收录的关于ACS后使用替卡格雷及氯吡格雷安全性比较的文献,根据纳入及排除标准筛选后,采用Review Manager 5.3软件进行Meta分析,得出最终效应值为优势比(OR),同时检验纳入文献的发表偏倚,并分析合并研究的敏感性.结果 共纳入12个研究,其中随机对照试验8篇,病例对照研究2篇,队列研究2篇,共86 849例患者.Cochrane系统评价手册的质量评价显示,多数文章在7个可能的风险方面均为低风险.采用Jadad量表对纳入的8篇随机对照研究进行评分(满分5分),得到3分的文献4篇,4分文献3篇,5分文献1篇,纳入文章质量普遍较高.Meta分析结果显示,与氯吡格雷相比,替卡格雷的心血管死亡率(OR=0.80,95％CI 0.72～0.89,P＜0.0001)及心肌梗死发生率(OR=0.78,95％CI 0.61～0.99,P=0.04)更低.结论 在ACS治疗中,替卡格雷相对于氯吡格雷有较低的心血管死亡率及心肌梗死发生率.%Objective To systemically evaluate the different on the incidence of cardiovascular events of platelet aggregation inhibitors ticagrelor and clopidogrel for acute coronary syndrome (ACS),so provide cardiovascular event reference for the selection ofACS platelet inhibitors.Methods Articles were collected according to the inclusion criteria from the database CNKI,Chongqing VIP,Taylor & Francis Open Access Journals,Wanfang,Cochrane Library,SinoMed,EMbase and PubMed from Jan.2000 to May 2017.Review Manager 5.3 was used for data analysis to get the odds ratio (OR) as final effect value.Publication bias of the literatures and the sensitivity of the study were also analyzed with the software.Results A total of 12 articles involving 86 849 patients were included,i.e.,8 random controlled trials,2 case control studies and 2 cohort studies.Quality assessment with Cochrane handbook for systematic reviews shows that,most studies gave low risks in 7 bias aspects.Jadad score assessment was employed in 8 random controlled trials,with 4 studies getting 3 points,3 getting 4 points and 1 getting 5 points,implying the significant quality of the included studies.Meta-analysis showed that compared with clopidogrel,significantly lower cardiovascular mortality (OR=0.80,95％CI:0.72-0.89,P＜0.01) and incidence of myocardial infarction (OR=0.78,95％CI:0.61-0.99,P＜0.05)were with ticagrelor.Conclusion Compared to clopidogrel,ticagrelor may lead to lower cardiovascular mortality and incidence of myocardial infarction in treatment of ACS.