摘要
目的:系统评价替格瑞洛与氯吡格雷分别用于急性ST段抬高型心肌梗死(st-elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的疗效和安全性。方法:检索中国知网(CNKI)、万方、中国生物医学文献服务系统(CBM)、维普(VIP)、Pub Med、EMBase、the Cochrane library等数据库(2000年1月—2017年1月),收集替格瑞洛与氯吡格雷分别联合阿司匹林用于STEMI患者PCI术后的随机对照试验,评价时间为规律用药6个月,筛选符合纳入标准的临床研究,应用Juni评分法对其进行评价,运用Rev Man 5.2软件进行文献荟萃(Meta)分析。结果:共纳入9篇文献,Meta分析结果显示,替格瑞洛组患者主要不良心脏事件发生率(OR=0.49,95%CI=0.35~0.67,P<0.05)、心肌梗死发生率(OR=0.39,95%CI=0.22~0.72,P<0.05)明显低于氯吡格雷组,差异均有统计学意义;两组患者卒中发生率(OR=0.36,95%CI=0.09~1.18,P=0.14)、出血发生率(OR=1.06,95%CI=0.76~1.49,P=0.72)的差异无统计学意义。结论:替格瑞洛用于急性STEMI患者PCI术后,可降低主要心血管事件、心肌梗死的发生率,患者卒中、出血发生率与使用氯吡格雷者相近。替格瑞洛具有替代氯吡格雷的潜力,特别是对于不能耐受氯吡格雷和有氯吡格雷抵抗的患者。
OBJECTIVE： To systematically evaluate respective efficacy and safety of ticagrelor and clopidogrel used for post-percutaneous coronary intervention（ PCI） in patients with Chinese acute ST-elevation myocardial infarction（ STEMI）. METHODS： Randomized controlled trials（ from Jan. 2000 to Jan. 2017） of ticagrelor and clopidogrel respectively combined with aspirin used for post-PCI in STEMI patients were collected from data bases included CNKI,Wangfang,CBM,VIP,Pub Med,EMBase,the Cochrane library,etc. Evaluation lasting time was 6 months of regular medication,clinical studies matched the criteria were filtrated and evaluated with Juni scoring method and analyzed by Rev Man 5. 2 software. RESULTS： A total of 9 studies were included,the results showed the incidence of adverse drug reactions（ OR = 0. 49,95% CI = 0. 35-0. 67,P〈0. 05） and myocardial infarction（ OR = 0. 39,95% CI = 0. 22-0. 72,P〈0. 05） of ticagrelor group were significantly lower than those of the clopidogrel group,with statistically significant differences; there was no statistical significance in the incidence of apoplexy（ OR = 0. 36,95% CI = 0. 09-1. 18,P = 0. 14）and hemorrhage（ OR = 1. 06,95% CI = 0. 76-1. 49,P = 0. 72） of two groups. CONCLUSIONS： The application of ticagrelor in post-PCI in STEMI patients can reduce major adverse cardiac event（ MACE） and incidence of myocardial infarction,there is no significant differences in incidence of apoplexy and hemorrhage. Ticagrelor has the potential to replace clopidogrel,especially for patients intolerant of clopidogrel and clopidogrel resisted.
出处
《中国医院用药评价与分析》
2017年第8期1094-1096,1100,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
