经CYP3A4代谢的他汀类药物对氯吡格雷抗血小板作用影响的系统评价  

Influence on antiplatelet effect of clopidogrel when co-administrated with different statins metabolized by CYP3A4

作　　者：牟金金[1,2] 杨敏[1,2] 余文韬[2] 蒋学华[1] 

机构地区：[1]四川大学华西药学院,四川成都610041 [2]四川大学华西医院药剂科,四川成都610041

出　　处：《中国新药与临床杂志》2013年第1期10-16,共7页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的系统评价经CYP3A4代谢的他汀类药物对氯吡格雷抗血小板作用的影响。方法检索Cochrane图书馆、PubMed、Embase、SCI数据库和中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国期刊全文数据库(CNKI),对纳入的随机对照试验(RCT)进行质量评价,采用RevMan 5.1软件对满足纳入标准的有关他汀类药物对氯吡格雷抗血小板作用的RCT研究进行Meta分析。选取最大血小板聚集率(MPAR)等作为观察指标,得出合并后的均数差值(MD)及其95%可信区间(CI)进行定量综合评估。结果共检索出1 511篇文献,符合标准的14篇RCTs研究进入Meta分析,结果显示不同他汀类药物联用氯吡格雷的主要心脑血管缺血事件组间无显著差异[RR=0.73,95%CI(0.47,1.12),P=0.15]。MPAR组间亦无显著差异[MD=0.04,95%CI(-1.26,1.35),P=0.95]。血小板颗粒膜糖蛋白CD62P表达组间差异不显著(P=0.31)。结论经CYP3A4途径代谢的阿托伐他汀并不影响氯吡格雷的抗血小板作用。AIM To evaluate the role of statins clopidogrel. METHODS Randomized controlled trials mainly metabolized by CYP3A4 on antiplatelet effects of （RCTs） evaluating the effects of statins on antiplatelet effects of clopidogrel were searched in Cochrane library, were evaluated and analyzed using RevMan 5.1 software. PubMed, Embase, SCI, CBM, VIP, CNKI. RCTs The primary outcome measures were maximal plateletaggregation rate. Meta- analyses were performed using mean difference （MD） for continuous data with 95% confidence intervals （CI）. RESULTS There were 1 511 trials be searched in this study. Fourteen RCTs were included in the analysis. No significant difference was observed in cardiac and cerebral ischemic events between two groups [RR = 0.73, 95%CI （0.47, 1.12） , P = 0.15]. There was no significant difference in maximal platelet aggregation rate [MD = 0.04, 95%CI （-1.26, 1.35）, P = 0.95]. The result of CD62P expression was also insignificant （P = 0.31）. CONCLUSION This systematic review shows that antiplatelet effect of clopidogrel is not attenuated by statins metabolized by CYP3A4.

关 键 词：氯吡格雷 阿托伐他汀 药物相互作用 血小板聚集抑制剂 Meta分析 细胞色素P-450 CYP3A 

分 类 号：R972.6[医药卫生—药品] R969.2[医药卫生—药学]