基于CYP2C19基因指导下替格瑞洛与氯吡格雷用于急性冠状动脉综合征疗效与安全性的meta分析  

Meta analysis for the efficacy and safety of ticagrelor and clopidogrel in acute coronary syndrome based on CYP2C19 gene

作　　者：李剑钦 杨星辰[1] 计嘉 史蔚青 LI Jian-qin;YANG Xing-chen;JI Jia;SHI Wei-qin(Department of Pharmacy,Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院药剂科,上海200032

出　　处：《世界临床药物》2020年第3期190-198,共9页World Clinical Drug

基　　金：龙华医院科研基金课题资助(Y1817)。

摘　　要：目的应用meta分析的方法评价CYP2C19基因多态性于急性冠状动脉综合征(acute coronary syndrome,ACS)患者使用替格瑞洛与氯吡格雷的疗效及安全性。方法计算机检索万方数据库、中国生物医学文献数据库、中国期刊全文数据库、维普数据库以及英文数据库SCI、Pubmed、Embase数据库,检索年限从建库到2019年6月。对收集的文献进行质量评价,使用STATA14.0软件对提取的数据进行meta分析。结果最终入选17篇文献,3812例患者,其中替格瑞洛组1421例、氯吡格雷组2391例。meta分析显示,在各亚组中,与氯吡格雷相比,替格瑞洛均能降低主要心血管不良事件(major adverse cardiac events,MACE)发生率(P<0.05),尤其是在CYP2C19慢代谢组中,或是与常规剂量的氯吡格雷相比,MACE发生率降低尤为显著(P<0.001);此外,在各亚组中,替格瑞洛与氯吡格雷相比,严重出血情况的差异均无统计学意义(P>0.05)。结论在ACS介入治疗中,替格瑞洛均能有效的减少MACE发生率,而两者的严重出血情况无显著差异。Objective To evaluate the efficacy and safety of CYP2C19 gene polymorphism in patients with acute coronary syndrome(ACS) using tegrarol and clopidogrel by meta-analysis.Methods Wanfang database,Chinese biomedical literature database,Chinese Journal Full-text Database,VIP database and English databases SCI,PubMed and Embase database were searched by computer.The retrieval period was from the establishment of the database to June 2019.The quality of the collected literature was evaluated,and the extracted data was analyzed by meta-analysis using STATA14.0 software.Results Among the 17 literatures,3 812 patients were selected,including 1 421 in tegrilol group and 2 391 in clopidogrel group.Meta-analysis showed that tegrerol reduced major adverse cardiovascular events in all subgroups compared with clopidogrel events(Mace)(P<0.05),especially in CYP2C19 gene slow metabolism group,or compared with the conventional dose of clopidogrel,mace incidence was significantly reduced(P<0.001).In addition,in each subgroup,compared with clopidogrel,tegrarol had no significant difference in severe bleeding(P>0.05).Conclusion Tegrarol can effectively reduce the incidence of mace in the interventional treatment of ACS,but there is no significant difference between the two groups.

关 键 词：替格瑞洛 氯吡格雷 急性冠状动脉综合征 基因多态性 META分析 

分 类 号：R541[医药卫生—心血管疾病] R973.2[医药卫生—内科学]