中国急性冠状动脉综合征人群应用替格瑞洛有效性和安全性的Meta分析  

The efficacy and safety of ticagrelor in Chinese patients with acute coronary syndrome:A Metaanalysis

作　　者：臧雁翔 刘广忠[1] 王健[1] 周俊松 李康 李为民[1] 陈默 ZANG Yan-xiang;LIU Guang-zhong;WANG Jian;ZHOU Jun-song;LI Kang;LI Wei-min;CHEN Mo(Department of Cardiology,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院心内科,黑龙江哈尔滨150001 [2]郑州工业应用技术学院

出　　处：《中国介入心脏病学杂志》2020年第6期328-336,共9页Chinese Journal of Interventional Cardiology

基　　金：哈尔滨高层次人才基金(2013SYYRCYJ06)。

摘　　要：目的研究中国急性冠状动脉综合征(ACS)人群应用替格瑞洛的有效性和安全性。方法检索PubMed、EMbase、考克兰图书馆、中国知网、万方医学网等数据库,研究设计类型为随机对照临床试验(RCT)或倾向性评分匹配(PSM)的观察性研究,检索时间由建库至2019年12月5日,结局指标包括有效性和安全性两方面,其中有效性指标包括首要终点事件(心原性死亡、心肌梗死或卒中)、次要终点事件(心原性死亡、全因死亡以及卒中),安全性指标包括出血、大出血和小出血。结果共纳入12项研究进行Meta分析,其中7项RCT、5项PSM。与氯吡格雷相比,中国ACS人群应用替格瑞洛后首要终点事件发生率降低38%(RR 0.62,95%CI 0.49~0.79,P<0.001),心原性死亡以及卒中发生率分别降低42%和40%(P<0.05),但并未降低全因死亡发生率。在安全性上,与氯吡格雷相比,中国ACS人群应用替格瑞洛后并未增加大出血发生率(RR 0.89,95%CI 0.72~1.08,P=0.232),但出血和小出血发生率分别增加了49%和86%(P<0.05)。结论中国ACS人群应用替格瑞洛能够改善预后,降低不良事件发生率,但出血事件发生率相应增加,以小出血事件为主。Objective This meta-analysis is aimed to summarize the efficacy and safety of ticagrelor in Chinese patients with acute coronary syndrome(ACS).Methods The databases of PubMed,EMBASE,Cochran library,CNKI and WANFANG medical network were searched.The types of the study were randomized controlled clinical trial(RCT)or observational study based on propensity score matching study(PSM).The retrieval time was from the establishment of the database to December 5,2019.The outcome indicators included effectiveness and safety,among which the effectiveness indicators included the primary end point(cardiac death,myocardial infarction or stroke),cardiac death,all-cause death,and stroke.The safety indicators included bleeding,major bleeding and minor bleeding.Results A total of 12 studies were included in this meta-analysis,including 7 RCTs and 5 PSMs.Compared with clopidogrel,the primary end point of Chinese patients with ACS was reduced by 38%(RR 0.62,95%CI 0.49–0.79,P<0.001),cardiac death and stroke by 42%and 40%,respectively(P<0.05),but no decrease in all-cause mortality with ticagrelor.In terms of safety indicators,compared with clopidogrel,ticagrelor in Chinese ACS population did not increase the incidence of major bleeding events(RR 0.89,95%CI 0.72–1.08,P=0.232),however,the overall bleeding and minor bleeding events increased by 49%and 86%,respectively(P<0.05).Conclusions Ticagrelor can improve the prognosis and reduce the adverse events in Chinese ACS population,but the number of bleeding events increases correspondingly,mainly of minor bleeding events.

关 键 词：急性冠状动脉综合征 中国人群 替格瑞洛 氯吡格雷 有效性 安全性 

分 类 号：R541.4[医药卫生—心血管疾病]