抗血小板联合抗凝治疗外周动脉疾病的有效性及安全性:meta分析  

Meta analysis of the effectiveness and safety of antiplatelet combined with anticoagulation therapy for peripheral arterial diseases

作　　者：曹又文 马江涛 杨睿睿 张建 陈志龙[1] 郑江华[1] CAO Youwen;MA Jiangtao;YANG Ruirui;ZHANG Jian;CHEN Zhilong;ZHENG Jianghua(Department of Vascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,P.R.China)

机构地区：[1]川北医学院附属医院血管外科,四川南充637000

出　　处：《中国普外基础与临床杂志》2024年第4期444-454,共11页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2022年市校科技战略合作专项基金项目(项目编号:22SXQT0017);2020年市校科技战略合作专项基金项目(项目编号:20SXZRKX0009)。

摘　　要：目的总结抗血小板联合抗凝治疗外周动脉疾病的有效性及安全性。方法通过Cochrane协作网制定的检索策略,检索截至2023年11月1日的国内外数据库中的相关研究文献,并使用Stata 14.0软件以及Cochrane协作网提供的Review Manager 5.4.1软件对结局指标进行meta分析。结果纳入符合要求的文献共15篇共15383例患者,其中抗血小板联合抗凝治疗(研究组)7692例,单行抗血小板治疗(对照组)7691例。meta分析结果:①症状:研究组的踝肱指数[均数差(mean difference,MD)及95%可信区间(95%confidence interval,95%CI)=0.04(0.02,0.06)]及最小腔内直径[MD(95%CI)=0.48(0.40,0.55)]均大于对照组,而血浆D-2聚体水平低于对照组[MD(95%CI)=–0.55(–0.57,–0.52)],肢体缺血风险概率低于对照组[风险比(risk ratio,RR)及95%CI=0.67(0.56,0.80)]。②血管通畅:研究组的血管通畅概率高于对照组[RR(95%CI)=1.13(1.08,1.17)];不同治疗方案干预后的结果显示,两种抗血小板药物(简称“双抗”)联合抗凝的血管通畅率最高[效应量(effect size,ES)及95%CI=0.90(0.86,0.94)],其他措施从高到低依次为单抗(即单用一种抗血小板药物)联合抗凝[ES(95%CI)=0.82(0.76,0.89)]、双抗[ES(95%CI)=0.79(0.72,0.85)]及单抗[ES(95%CI)=0.71(0.54,0.87)];不同抗凝药物种类进行干预后的结果显示,研究组中采用维生素K拮抗剂的血管通畅概率高于对照组[RR(95%CI)=1.15(1.10,1.20)],而研究组中采用Ⅹa抑制剂的血管通畅概率与对照组比较差异无统计学意义[RR(95%CI)=1.04(0.95,1.15)]。③出血:研究组出血风险高于对照组[RR(95%CI)=1.55(1.27,1.89)];不同干预措施的出血率在单抗治疗最低[ES(95%CI)=0.02(0.01,0.02)],其他措施的出血率从低到高依次为单抗联合抗凝[ES(95%CI)=0.04(0.03,0.06)]、双抗[ES(95%CI)=0.08(0.06,0.10)]及双抗联合抗凝[ES(95%CI)=0.12(0.06,0.18)];不同抗凝药物种类进行干预后研究组中采用维生素K拮抗剂及采用Ⅹa抑制剂的出血发生概�Objective To summarize the effectiveness and safety of antiplatelet combined with anticoagulant therapy for peripheral arterial disease(PAD).Method Using the search strategy developed by Cochrane Collaborative Network,the relevant literature from domestic and foreign databases as of November 1,2023 was searched and a metaanalysis of outcome indicators was conducted using Stata 14.0 software and Review Manager 5.4.1 software provided by Cochrane Collaboration Network.Results A total of 15 eligible literature and 15383 patients were included,including 7692 in the antiplatelet combined with anticoagulant therapy group(study group)and 7691 in the control group(only antiplatelet drug therapy).The meta-analysis results showed that:①Symptoms:The ankle brachial index[mean difference(MD)and 95%confidence interval(95%CI)=0.04(0.02,0.06)]and the minimum lumen diameter[MD(95%CI)=0.48(0.40,0.55)]of the study group were greater than those of the control group;The plasma D-2 dimer level of the study group was lower than that of the control group[MD(95%CI)=–0.55(–0.57,–0.52)],and the probability of the limb ischemia risk of the study group was lower than that of the control group[risk ratio(RR)and 95%CI=0.67(0.56,0.80)].②Vascular patency:The probability of the vascular patency of the study group was higher than that of the control group[RR(95%CI)=1.13(1.08,1.17)];The subgroup analysis results:the vascular patency rate of the two antiplatelet drugs combined with anticoagulation therapy was highest among the different treatment regimens[effect size(ES)and 95%CI=0.90(0.86,0.94)],which of the other measures in descending order was only one antiplatelet drug combined with anticoagulation therapy[ES(95%CI)=0.82(0.76,0.89)],two antiplatelet drugs therapy[ES(95%CI)=0.79(0.72,0.85)],and only one antiplatelet drug therapy[ES(95%CI)=0.71(0.54,0.87)];The probability of the vascular patency using vitamin K antagonists in the study group was higher than that in the control group[RR(95%CI)=1.15(1.10,1.20)],which had no statistical di

关 键 词：抗血小板治疗 抗凝治疗 外周动脉疾病 META分析 

分 类 号：R543.5[医药卫生—心血管疾病]