摘要
目的系统评价冠状动脉旁路移植术(CABG)后阿司匹林联合氯吡格雷抗血小板治疗的有效性和安全性。方法计算机检索The Cochrane Library(2013第2期)、PubMed、EMbase、CBM、CNKI、WanFang Data和VIP,收集有关CABG后抗血小板治疗的随机对照试验(RCT),检索时限均为从建库至2013年9月,由2位评价者根据纳入与排除标准独立选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入6个RCT,共计901例患者,其中阿司匹林联合氯吡格雷组(A+C组)449例,阿司匹林联合或不联合安慰剂组(A+P组)452例。Meta分析结果显示:与A+P组相比,A+C组能显著降低CABG术后大隐静脉桥闭塞率[RR=0.59,95%CI(0.43,0.80),P=0.000 6],但在左乳内动脉桥闭塞率[RR=0.88,95%CI(0.35,2.18),P=0.78]、桡动脉桥闭塞率[RR=0.43,95%CI(0.13,1.46),P=0.18]、胸液引流量[MD=–1.68,95%CI(–48.69,45.32),P=0.94]、主要出血事件发生率[RR=1.20,95%CI(0.39,1.65),P=0.75]、主要心血管事件发生率[OR=0.81,95%CI(0.38,1.72),P=0.58]及30天内病死率[RR=0.64,95%CI(0.17,2.44),P=0.52]方面,两组无显著差异。结论在降低CABG术后大隐静脉桥闭塞率方面,A+C组的疗效优于A+P组。受纳入研究质量和数量所限,上述结论仍需开展更多高质量的RCT加以验证。
Objective To systematically review the effectiveness and safety of aspirin-clopidogrel combined antiplatelet therapy after coronary artery bypass grafting （CABG）. Methods Databases including The Cochrane Library （Issue 2, 2013）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to September 2013 for randomized controlled trials （RCTs） about aspirin-clopidogrel combined anti-platelet therapy after CABG. Two reviewers selected literature independently according to the inclusion and exclusion criteria. After data extraction and methological quality assessment of the included studies, meta-analysis was performed using RevMan 5.2 software. Results A total of six RCTs involving 901 patients were included, of which 449 cases were in the aspirin-clopi- dogrel group （A＋C） and 452 cases were in the aspirin with or without placebo group （A＋P）. The results of meta-analysis showed that： compared with A＋P, A＋C significantly reduced occlusion rates of the saphenous vein graft （RR=0.59, 95% CI 0.43 to 0.80, P=0.000 6）. But no significant difference was found between the two groups in occlusion rates of the left internal mammary artery graft （RR=0.88, 95% CI 0.35 to 2.18, P=0.78）, radial artery graft （RR=0.43, 95% CI 0.13 to 1.46, P=0.18）, pleural fluid drainage volume （MD= -1.68, 95%CI -48.69 to 45.32, P=0.94）, incidence of major bleeding events （RR=I.20, 95% CI 0.39 to 1.65, P=0.75）, ma）or cardiovascular events （OR=0.81, 95% CI 0.38 to 1.72, P=0.58）, and mortal- ity within 30 days （RR=0.64, 95% CI 0.17 to 2.44, P=0.52）. Conclusion In reducing occlusion rates of the saphenous vein graft, the A＋C group is more effective than the A＋P group. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
出处
《中国循证医学杂志》
CSCD
2014年第8期958-965,共8页
Chinese Journal of Evidence-based Medicine
