摘要
目的系统评价经皮冠状动脉介入术后双联抗血小板治疗的病程、疗效及安全性的关系。方法计算机检索Cochrane Library、MEDLINE、EMbase、CBM、CNKI和WanFang Data,纳入所有比较经皮冠脉介入术后双联抗血小板短疗程(≤6个月)与长疗程(>6个月)疗效及安全性比较的随机对照试验(RCT)和观察性研究,由两名评价员按照纳入与排除标准选择文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入8篇文献,其中3个为RCT(共计7475例患者),5个为队列研究(共计12744例患者)。对RCT的Meta分析结果显示:长疗程双联抗血小板治疗组的死亡或心肌梗死事件发生率较短疗程组低[OR=0.74,95%CI(0.56,0.98),P<0.0001];短疗程组出现严重出血事件的发生率较长疗程组低,但两组差异无统计学意义[OR=1.29,95%CI(0.99,1.69),P=0.06]。对观察性研究的Meta分析结果显示:长疗程组的死亡或心梗发生率较短疗程组低[OR=0.7,95%CI(0.45,1.08),P=0.11],应用Meta回归探讨队列研究间的异质性,结果提示研究年限、随访时间对异质性有贡献(Z=3.61,P=0.000);而且长疗程组的晚期支架内血栓也较短疗程组发生率低[OR=0.40,95%CI(0.15,1.07),P=0.07]。结论经皮冠状动脉介入术后长疗程(>6个月)双联抗血小板治疗能降低患者死亡或心肌梗死的发生率,而不会明显增加严重出血事件发生率;同时,长疗程组还有降低晚期支架内血栓发生的趋势。但更长疗程双联抗血小板治疗(>12月)则未见明显优势。
Objective To assess the effectiveness and safety of different dual antiplatelet therapies in patients undergoing percutaneous coronary intervention.Methods Such databases as The Cochrane Library,MEDLINE,EMbase,CBM,CNKI and WanFang Data were searched to collect the randomized controlled trials（RCTs） and observational studies on the effectiveness and safety of dual antiplatelet therapies both short-duration（≤6 months） and long-duration（6 months） after percutaneous coronary intervention.The literature was screened according to the inclusive and exclusive criteria by two reviewers independently,the quality was evaluated,the data were extracted,and meta-analyses were performed by using RevMan 5.1 software.Results Eight trials were included,of which 3 were RCTs involving 7475 patients,and 5 were observational studies involving 12744 patients.Meta-analyses on RCTs showed that the incidence of death or myocardial infarction in the long-duration treatment group was lower than that of the short-duration treatment group（OR=0.74,95%CI 0.56 to 0.98,P〈0.0001）,while meta-analyses on observation studies showed the similar result（OR=0.7,95%CI 0.45 to 1.08,P=0.11）.With the variables of published year and follow-up time,the heterogeneity of cohort studies was discussed through meta-regression（Z=3.61,P=0.000） which indicated that both published year and follow-up time might be the source of heterogeneity due to their contribution.For RCTs,the incidence of severe bleeding events in the short-duration treatment group was lower than that in the long-duration treatment group（OR=1.29,95%CI 0.99 to 1.69,P=0.06）.For observational studies,the incidence of late stent thrombosis in the long-duration treatment group was lower than that in the short-duration treatment group（OR=0.40,95%CI 0.15 to 1.07,P=0.07）.Conclusion The long duration（6months） of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction and decrease the tendency of late stent thrombosis,but cannot obviously increase the incidence rate of severe bleeding events.The current evidence shows no marked superiority in longer duration（12months） of dual antiplatelet therapy.
出处
《中国循证医学杂志》
CSCD
2012年第5期577-582,共6页
Chinese Journal of Evidence-based Medicine
基金
新疆乌鲁木齐市科学技术计划"经皮冠状动脉介入治疗后氯吡格雷的个体化应用研究"(编号:Y101310008)
关键词
经皮冠脉介入术
抗血小板治疗
Meta分析
系统评价
随机对照试验
队列研究
Percutaneous coronary intervention
Antiplatelet therapy
Meta-analysis
Systematic review
Rand-omized controlled trial
Cohort study
