经皮冠状动脉介入治疗术后应用双联抗血小板联合质子泵抑制剂安全性和有效性的荟萃分析  

Meta-analysis on safety and efficacy of dual antiplatelet therapy combining with proton pump inhibitors for patients after percutaneous coronary intervention

作　　者：车千秋 吴强[1] 梁宇博 孙润民 吕倩文 马俊丽 胡浩[1] 林欣[1] 许广莉[1] 孙守刚[1] 张春[1] 王琼英[1] 余静[1] 白锋[1] Che Qianqiu;Wu Qiang;Liang Yubo;Sun Runmin;Lyu Qianwen;Ma Junli;Hu Hao;Lin Xin;Xu Guangli;Sun Shougang;Zhang Chun;Wang Qiongying;Yu Jing;Bai Feng(Department of Cardiology, Lanzhou University Second Hospital, Lanzhou 730030, China)

机构地区：[1]兰州大学第二医院心内科,730030

出　　处：《中华心血管病杂志》2019年第2期129-140,共12页Chinese Journal of Cardiology

基　　金：兰州大学第二医院院内博士基金(sdkyjj-10,ynbskyjj2015-1-11);兰州市人才新创业项@(2016-RC-104,2016-RC-54);甘肃省卫生行业科研计划项目(GSWSKY2016-53).

摘　　要：目的 分析经皮冠状动脉介入治疗(PCI)术后给予患者双联抗血小板(DAPT)治疗联用与不联用质子泵抑制剂(PPI)对主要结局指标的影响.方法 该研究为荟萃分析.计算机检索英文数据库PubMed、EMBASE、Cochrane Library,并追踪已获文献的参考文献,手工检索国际上重要会议论文集.检索时间至2017年9月.按照Cochrane系统评价要求制定纳入、排除标准.检索共获文献977篇,排除重复文献193篇,排除综述、病例报告、书信、系统评价共74篇,阅读题目和摘要后又排除文献667篇,排除非随机对照、结局指标不相关文献34篇,最终纳入文献9篇,包括患者共16 589例.运用RevMan 5.3软件比较PCI术后DAPT联用PPI和单用DAPT患者主要不良心血管事件(MACE)、心原性死亡、心肌梗死、靶血管再次血运重建、全因死亡、支架内血栓形成、卒中、消化道出血及胃肠道事件发生率.结果 纳入的9篇文献中有8篇观察了MACE,结果显示6 282例接受DAPT联合PPI治疗的患者中561例发生MACE,9 632例单用DAPT的患者中951例发生MACE,二者MACE发生率差异无统计学意义(OR=1.15,95%CI 0.88~1.51,P>0.05).纳入的9篇文献中有7篇观察了心原性死亡,结果显示6 453例接受DAPT联合PPI治疗的患者中172例发生心原性死亡,9 839例单用DAPT的患者中321例发生心原性死亡,二者心原性死亡发生率差异无统计学意义(OR=0.97,95%CI 0.80~1.18,P>0.05).纳入的9篇文献中8篇观察了再次心肌梗死,结果显示6 282例接受DAPT联合PPI治疗的患者中416例再次发生心肌梗死,9 632例单用DAPT治疗的患者中691例再次发生心肌梗死,二者心肌梗死再次发生率差异无统计学意义(OR=1.01,95%CI 0.89~1.16,P>0.05).纳入的9篇文献中有4篇观察了血运重建,结果显示2 173例接受DAPT联合PPI治疗的患者中64例发生血运重建,2 770例单用DAPT的患者中105例发生血运重建,二者血运重建发生率差异无统计学意义(OR=1.33,95%CI0.55~3.24,P>0.Objective To analyze the impact of dual antiplatelet (DAPT) therapy combining with or without proton pump inhibitors (PPI) on the main outcomes after percutaneous coronary intervention (PCI).Methods The PubMed,EMBASE and Cochrane Library were searched for relevant literature and the references obtained from these sources were retrieved manually from inception till September 2017.Inclusion and exclusion criteria were established follow the Cochrane review standard.A total of 977 literatures were included,193 duplicates were excluded,74 reviews,case reports,letters and systematic reviews were excluded,667 literatures were excluded after reading the title and abstract,34 literatures were excluded due to non-randomized control studies and unrelated outcome indicators,and 9 literatures were finally included with a total of 16 589 patients.RevMan 5.3 software was used to compare the incidence of major adverse cardiovascular events (MACE),cardiogenic death,recurrent myocardial infarction,target vessel revascularization,all-cause death,stent thrombosis,stroke,gastrointestinal bleeding and gastrointestinal events in patients with DAPT combining with or without PPI after PCI.Results MACE was observed in 8 out of the 9 included literatures,and the results showed that MACE occurred in 561 out of 6 282 patients receiving DAPT combining with PPI therapy and in 951 out of 9 632 patients using DAPT alone (OR=1.15,95%CI 0.88-1.51,P>0.05).Cardiogenic death was observed in 7 out of the 9 included literatures,and the results showed that cardiogenic death occurred in 172 out of 6 453 patients receiving DAPT combining with PPI treatment and in 321 out of the 9 839 patients using DAPT alone (OR=0.97,95%CI 0.80-1.18,P>0.05).Recurrent myocardial infarction was observed in 7 out of the 9 included literatures,the results showed 416 out of 6 282 cases in DAPT combining with PPI therapy group experienced recurrent myocardial infarction and 691 out of 9 632 cases in DAPT group experienced recurrent myocardial infarction (OR=1.01,95%CI 0.89-1.

关 键 词：冠状动脉疾病 质子泵抑制剂 经皮冠状动脉介入治疗 双联抗血小板治疗 

分 类 号：R541.4[医药卫生—心血管疾病]