质子泵抑制剂预防双联抗血小板治疗相关上消化道出血的系统评价  

Proton pump inhibitor in prevention of dual antiplatelet therapy associated upper gastrointestinal bleeding:A systematic review and Meta-analysis of randomized controlled trials

作　　者：莫晨[1] 吴小娥[1] 黄燕苹[1] 陕海丽[1] 徐铭宝[1] 

机构地区：[1]武警总医院干部病房二科,北京100039

出　　处：《临床消化病杂志》2017年第5期275-283,共9页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]系统评价质子泵抑制剂(pronton pump inhibitor,PPI)对于阿司匹林与氯吡格雷双联抗血小板治疗(dual antiplatelet therapy,DAPT)相关的上消化道出血的预防效果及安全性,为临床提供最佳循证证据。[方法]检索MEDLINE、EMBASE、the Cochrane Controlled Trials Register、中国知网(Chinese National Knowledge Infrastructure,CNKI)、万方和中国生物医学文献数据库(Chinese Biomedical Literature Database,CBM),时间自建库至2015年5月。纳入所有PPI联合双联抗血小板治疗(长期口服低剂量阿司匹林及氯吡格雷)并报告消化道不良事件及心血管不良事件的RCT,比较PPI与对照组(安慰剂、黏膜保护剂吉法酯和H2RA法莫替丁)对双联抗血小板治疗相关上消化道出血的预防效果。对于符合纳入标准的RCT进行资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。[结果]共纳入21个RCT,9 427例患者。Meta分析结果显示,对于低剂量阿司匹林及氯吡格雷双联抗血小板治疗的患者,PPI能够有效预防上消化道出血(OR=0.24,95%CI:0.16,0.35)的发生并且未增加主要心血管不良事件(OR=0.98,95%CI:0.81,1.18)的发生。[结论]PPI能够有效预防DAPT相关上消化道出血;PPI与低剂量阿司匹林及氯吡格雷联用未增加心血管不良事件。PPI预防DAPT相关的上消化道出血安全有效。[Objective]To determine the prevention effect and security of proton pump inhibitor（PPI）in the dual antiplatelet therapy（DAPT）associated upper gastrointestinal bleeding and to provide the best evi- dence to the clinical practice. [Methods]We searched MEDLINE,EMBASE,the Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure（CNKI）, Wanfang Data and Chinese Biomedical Liter- ature Database（CBM）from inception to May 2015, and checked conference abstracts for randomized con- trolled trials（RCTs）that reported both upper gastrointestinal bleeding（UGIB）and major adverse cardiovas- cular events（MACE）in patients taking PPI with low dose aspirin（LDA）and clolpidogrel. The prevention effects and MACE of PPIs and control group（placebo,blank control and histamine 2 receptor antagonist）in DAPT associated upper GI bleeding were compared. Meta-analysis was performed using RevMan 5.2 soft- ware./Results]Our review evaluated 9 427 participants in 21 RCTs. For the patients with dual antiplatelet therapy with LDA and clopidogrel,PPls were able to prevent the DAPT associated GI bleeding（OR=0.24, 95%CI： O. 16,0.35）without increasing MACE（OR = 0.98,95% CI： O. 81,1.18）. I-Conclusion] PPIs are ef- fective and safe in the prevention of DAPT associated upper GI bleeding.

关 键 词：上消化道出血 质子泵抑制剂 低剂量阿司匹林 氯吡格雷 主要心血管不良事件 Meta分析 随机对 照试验 

分 类 号：R54[医药卫生—心血管疾病] R573.2[医药卫生—内科学]