氯吡格雷与质子泵抑制剂联用治疗冠心病安全性的系统评价  

Safety of Clopidogrel-Proton Pump Inhibitors Combination Therapy on Cardiovascular Events: A Systematic Review

作　　者：邝洁云[1,2] 谭洁[1] 邹建军[1] 陈绍良[3] 

机构地区：[1]南京医科大学附属南京第一医院临床药理实验室,南京210006 [2]中国药科大学江宁校区药学院,南京211198 [3]南京医科大学附属南京第一医院心内科,南京210006

出　　处：《中国循证医学杂志》2011年第3期283-291,共9页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金资助项目(编号:30901830);南京市科技发展计划项目(编号:201001098);南京医科大学重点项目课题(编号:09NJMUZ36)

摘　　要：目的对冠心病患者单用氯吡格雷和联合使用氯吡格雷质子泵抑制剂(PPI)的安全性(心血管事件、死亡或胃肠道出血等)进行系统评价。方法计算机检索Cochrane图书馆、PubMed、EMbase、SSCI、VIP、CNKI及CBM数据库,检索时间均从建库至2010年9月,并追踪已获文献的参考文献,由2名研究者独立进行质量评价及数据提取,而后采用RevMan 5.0软件进行Meta分析。结果共纳入29篇文献,合计142 401例患者。Meta分析结果显示:氯吡格雷与质子泵抑制剂联用有增加心血管事件的风险[RR=1.27,95%CI(1.09,1.47)],同时存在增加心肌梗死[RR=1.45,95%C(I1.20,1.76)]、总病死率[RR=1.23,95%C(I1.06,1.43)]、再次血栓[RR=1.37,95%C(I1.01,1.86)]的风险。此外,两者联用与胃肠道出血风险的关系还不明确[RR=0.84,95%CI(0.47,1.50)]。结论氯吡格雷与质子泵抑制剂联用会增加心血管事件、病死率、心肌梗死及再次血栓的风险,但在降低胃肠道出血的作用方面尚需更多临床研究证实。Objective To perform a systematic review on the safety（i.g.cardiovascular,mortality and gastrointestinal bleeding） of clopidogrel versus clopidogrel combined with proton pump inhibitors（PPIs） for the patients with coronary heart disease.Methods Such databases as The Cochrane Library,PubMed,EMbase,SSCI,VIP,CNKI,and CBM were searched from the date of their establishment to September 2010.The bibliographies of the retrieved articles were also checked.The data was extracted and evaluated by two reviewers independently.The RevMan 5.0 software was used for meta-analyses.Results A total of 29 studies were included.The results of meta-analyses showed that the use of clopidogrel combined with PPIs was associated with increasing the risk of cardiovascular events（RR=1.27,95%CI 1.09 to 1.47）,as well as myocardial infarction（RR=1.45,95% CI 1.20 to 1.76）,total mortality（RR=1.23,95%CI 1.06 to 1.43）,and rethrombosis（RR=1.37,95%CI 1.01 to 1.86）.However,there was no enough evidence to reach the conclusion that the combination use could benefit the situation of gastrointestinal bleeding（RR=0.84,95%CI 0.47 to 1.50）.Conclusion Compared with clopidogrel,the combination use of clopidogrel and PPIs increases cardiovascular events,mortality,and the risks of myocardial infarction and rethrombosis.However,more clinical studies are required to assess the effect of reducing gastrointestinal bleeding.

关 键 词：氯吡格雷 质子泵抑制剂 心血管事件 消化道出血 系统评价 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]