替格瑞洛对比普拉格雷对血小板反应性影响的Meta分析  

Effect of Ticagrelor versus Prasugrel on Platelet Reactivity:A Meta-analysis

作　　者：吴禹蒙[1] 程荔春[2] 梁晶[1] 刘利龙 孙向菊[1] 宋佳[1] 吴玉波[1] 

机构地区：[1]哈尔滨医科大学附属第四医院药学部,哈尔滨150001 [2]大连医科大学附属第二医院药学部,辽宁大连116027

出　　处：《中国药房》2016年第15期2083-2086,共4页China Pharmacy

摘　　要：目的:系统评价替格瑞洛对比普拉格雷对血小板反应性的影响,以为临床治疗提供循证参考。方法:计算机检索Pub Med、中国期刊全文数据库和万方数据库,收集替格瑞洛对比普拉格雷对血小板反应性影响的随机对照试验(RCT)和对照试验,对符合纳入标准的临床研究进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价,再采用Rev man 5.1统计软件进行Meta分析。结果:共纳入17项RCT,合计2 757例患者。Meta分析结果显示,负荷剂量下,无论采用Verify Now P2Y12(VN)检测法[MD=15.43,95%CI(-0.39,31.25),P=0.06]或血管扩张刺激磷酸蛋白(VASP)检测法[MD=-3.04,95%CI(-8.98,2.90),P=0.32],替格瑞洛与普拉格雷对血小板反应性的效果相当,两组比较差异均无统计学意义;维持剂量下,无论采用VN检测法[MD=-48.94,95%CI(-58.04,-39.84),P<0.001]或VASP检测法[MD=-14.32,95%CI(-20.45,-8.20),P<0.001],替格瑞洛对血小板反应性的效果均优于普拉格雷,两组比较差异均有统计学意义。结论:在初期负荷剂量使用抗血小板药物时,选用替格瑞洛或普拉格雷对血小板反应性的影响没有显著差异,而后期维持剂量使用抗血小板药物时,替格瑞洛对血小板反应性的效果优于普拉格雷。OBJECTIVE：To systematically review the effect of ticagrelor versus prasugrel on platelet reactivity,and provide evidence-based reference for clinical treatment. METHODS：Retrieved from Pub Med,CJFD and Wanfang Database,randomized controlled trials（RCT）about the effect of ticagrelor versus prasugrel on platelet reactivity were collected. Meta-analysis was performed by using Rev Man software after data extract and quality evaluation by Cochrane 5.1.0. RESULTS：Totally 17 RCTs were enrolled,involving 2 757 patients. Results of Meta-analysis showed,regardless of Verity Now（VN）detection method [MD=15.43,95%CI（-0.39,31.25）,P=0.06] or vasodilator stimulus phosphoprotein（VASP）detection method [MD=-3.04,95%CI（-8.98,2.90）,P=0.32],ticagrelor and prasugrel had the same effects on platelet reactivity under loading dose,the differences were not statistically significant;regardless of VN detection method [MD=-48.94,95%CI（-58.04,-39.84）,P〈0.001] or VASP detection method [MD=-14.32,95%CI（-20.45,-8.20）,P〈0.001],the effects of ticagrelor were better than prasugrel on platelet reactivity under maintenance dose,the differences were statistically significant. CONCLUSIONS：At the loading dose,there was no difference between ticagrelor and prasugrel,but ticagrelor has more benefits than prasugrel under maintenance dose.

关 键 词：替格瑞洛 普拉格雷 血小板反应性 META分析 

分 类 号：R969.3[医药卫生—药理学]