活血化瘀中药治疗氯吡格雷抵抗随机对照试验的Meta分析  

Efficacy of Blood-activating and Stasis-dissolving Chinese Medicines on Clopidogrel Resistance:a Meta-analysis of Randomized Controlled Trials

作　　者：戴璐璐 蒋跃绒[1,2] 陈可冀 DAI Lulu;JIANG Yuerong;CHEN Keji(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;National Clinical Research Center for Chinese Medicine Cardiology,Beijing 100091,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]国家中医心血管病临床医学研究中心,北京100091

出　　处：《中西医结合心脑血管病杂志》2023年第3期394-400,共7页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：中国中医科学院科技创新工程项目(No.CI2021A00908)。

摘　　要：目的:系统评价活血化瘀中药治疗氯吡格雷抵抗(CR)的临床疗效。方法:计算机检索中国学术期刊全文数据库(CNKI)、万方数据库(WanFang Data)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、the Cochrane Library、PubMed、Web of Science和EMbase数据库中有关活血化瘀中药治疗氯吡格雷抵抗的随机对照试验,检索时限为建库至2021年5月15日。对符合纳入标准的文献采用Cochrane Reviewer′s Handbook(version 5.1)推荐的风险偏倚评估工具行方法学质量评价。提取病人一般资料及血小板聚集率、不良反应发生情况。采用RevMan 5.4软件进行Meta分析。结果:共纳入7篇文献,涉及氯吡格雷抵抗病人557例。Meta分析结果显示,活血化瘀中药联合氯吡格雷组(试验组)的血小板聚集率较单用氯吡格雷组(对照组)显著降低[MD=-7.57,95%CI(-8.45,-6.69),P<0.00001]。亚组分析结果提示,在疗程方面,无论疗程<14 d[MD=-7.14,95%CI(-8.14,-6.14),P<0.00001],还是疗程≥14 d[MD=-9.07,95%CI(-10.94,-7.20),P<0.00001],活血化瘀中药均可有效降低血小板聚集率。结论:现有证据显示,活血化瘀中药可有效降低血小板聚集率,改善氯吡格雷抵抗。但纳入研究数量有限且质量不高,所得结论有待更多高质量的随机对照试验进一步验证。Objective:To evaluate the efficacy of blood-activating and stasis-dissolving Chinese medicines on clopidogrel resistance(CR).Methods:Literatures were identified by searching the China National Knowledge Infrastructure(CNKI),WanFang Database,Wipro Chinese Full-text Database of Scientific and Technological Journals(VIP),China Biology Medicine disc(CBM),the Cochrane Library,PubMed,and Web of Science and EMbase from inception to May 15,2021.The risk bias assessment tool of Cochrane Reviewer′s Handbook(version 5.1)was used to assess the methodological quality of literatures meeting the inclusion criteria.General information and platelet aggregation rate were extracted.RevMan 5.4 software was used to perform Meta-analysis.Results:Seven literatures with 557 clopidogrel resistant patients were included.Meta-analysis results showed that platelet aggregation rate of blood-activating and stasis-dissolving Chinese medicine combined with clopidogrel group(test group)was significantly lower than that of clopidogrel group(control group)[MD=-7.57,95%CI(-8.45,-6.69),P<0.00001].Subgroup analysis showed that course of treatment was less than 14 days[MD=-7.14,95%CI(-8.14,-6.14),P<0.00001],or more than 14 days[MD=-9.07,95%CI(-10.94,-7.20),P<0.00001],combined application of blood-activating and stasis-dissolving Chinese medicine could effectively reduce the platelet aggregation rate.Conclusion:The available evidence suggests that,blood-activating and stasis-dissolving Chinese medicine can effectively reduce the platelet aggregation rate and improve clopidogrel resistance.However,due to the limited number and low quality of included literatures,the conclusions need to be further verified by more high-quality RCTs.

关 键 词：氯吡格雷抵抗 活血化瘀中药 血小板聚集率 META分析 

分 类 号：R285.6[医药卫生—中药学]