急性STEMI患者行PCI术后应用替格瑞洛治疗的疗效及安全性Meta分析  

Meta-analysis of Efficacy and Safety of Ticagrelor in Patients with Acute STEMI after PCI

作　　者：林嫚婷 苏亚霞 李胜[2] 胡汉昆[1] Lin Manting;Su Yaxia;Li Sheng;Hu Hankun(Department of Pharmacy,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Biological Repositories,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院药学部,武汉430071 [2]武汉大学中南医院生物样本库,武汉430071

出　　处：《药物流行病学杂志》2020年第4期221-226,232,共7页Chinese Journal of Pharmacoepidemiology

基　　金：湖北省重大科技创新计划项目(编号:2013ACA006);武汉大学中南医院科技创新培育基金项目(编号:cxpy2017023);2018~2019年度湖北省卫生健康委员会中医药科研项目(编号:ZY2019M033);2018年第二批武汉大学中南医院创新培育基金重点国际(地区)合作研究培育项目(编号:znpy2018116);武汉大学医学部教学改革研究项目(编号:2019059)。

摘　　要：目的:系统评价替格瑞洛对比氯吡格雷在急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术后的抗血小板治疗中的疗效及安全性,为临床用药提供循证参考。方法:计算机检索PubMed、Embase、the Cochrane Library、WanFang Data、CNKI、VIP和SinoMed数据库,搜集比较替格瑞洛和氯吡格雷治疗急性STEMI并行PCI术后的患者的随机对照试验(RCT),检索时限均为建库至2019年10月31日,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入16个RCT,合计2457例患者。Meta分析结果显示,替格瑞洛组患者二磷酸腺苷(ADP)途径血小板抑制率显著高于氯吡格雷组[MD=5.73,95%CI(2.88,8.58),P<0.0001],主要不良心血管事件(MACE)发生率显著低于氯吡格雷组[OR=0.32,95%CI(0.24,0.43),P<0.00001],差异均有统计学意义。两组患者的出血发生率比较,差异无统计学意义[OR=1.23,95%CI(0.91,1.64),P>0.05]。结论:对于急性STEMI并行PCI术后的患者使用替格瑞洛进行抗血小板治疗的疗效显著优于氯吡格雷,能提高血小板抑制率,减少MACE发生率;在安全性方面,两者的主要不良出血事件发生率相近。Objective:To systematically evaluate the efficacy and safety of ticagrelor versus clopidogrel in antiplatelet therapy after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI),and to provide evidence-based reference for clinical medication.Methods:PubMed,Embase,the Cochrane Library,WanFang Data,CNKI,VIP and SinoMed databases were electronically searched to collect randomized controlled trials(RCTs)of ticagrelor and clopidogrel in patients with acute STEMI after PCI from inception to October 31,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was performed using RevMan 5.3 software.Results:Totally 16 RCTs were included,involving 2457 patients.Meta-analysis showed that the platelet inhibition rate in adenosine diphosphate(ADP)pathway was significantly higher in the ticagrelor group than in the clopidogrel group(MD=5.73,95%CI 2.88 to 8.58,P<0.0001),and the incidence of major adverse cardiovascular events(MACE)was significantly lower than that in the clopidogrel group(OR=0.32,95%CI 0.24 to 0.43,P<0.00001).There was no significant difference in the incidence of bleeding between the two groups(OR=1.23,95%CI 0.91 to 1.64,P>0.05).Conclusion:Antiplatelet therapy with ticagrelor is more effective than clopidogrel in patients with acute STEMI and PCI.It can improve platelet inhibition rate and reduce the incidence of MACE.In terms of safety,the incidence of major adverse bleeding events is similar.

关 键 词：替格瑞洛 氯吡格雷 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 META分析 随机对照试验 

分 类 号：R973.2[医药卫生—药品]