摘要
目的总结整理国内外关于阿司匹林服用时间的随机对照实验并采用meta分析法评估更合适的阿司匹林服用时间。方法制定原始文献的纳入标准、排除标准及检索策略,在Medline、EMBASE、Cochrane图书馆等进行相关的文献检索。检索文献时间均从建库至2018年11月。研究指标包括不同时间服用阿司匹林后的平均收缩压及舒张压、血小板活性及血小板聚集率、ADP值变化情况以及服药后不良反应发生率。应用RevMan 5.3软件进行数据处理,计量资料的效应尺度以加权数差(MD)及其95%CI表示,计数资料的效应尺度以比值比(OR)及其95%CI表示。结果共检索到80篇文献,最后纳人15篇。Meta分析结果显示,晨起与睡前服用小剂量阿司匹林对收缩压影响差异无统计学意义(MD=1.57,95%CI:-0.34-3.48),睡前比晨起服用小剂量阿司匹林更能降低受试者的舒张压(MD=6.28,95%CI:0.18-3.94),睡前比晨起服用小剂量阿司匹林更能降低受试者的血小板活性(MD=21.08,95%CI:9.73-32.44),而对血小板聚集率的影响无统计学意义(MD=-0.17,95%CI:-5.66-5.32),餐前服用小剂量阿司匹林肠溶片的不良反应发生率低于餐后服用同等剂量的阿司匹林肠溶片(OR=0.18,95%CI:0.09-0.35)。结论对于患有心血管疾病的患者,睡前服用小剂量阿司匹林肠溶片比晨起服用更能有效地降低血小板活性,在一定程度上也能降低血压,餐前服用小剂量阿司匹林肠溶片比餐后服用的不良反应发生率更低。
Objective To summarize the randomized controlled trials on aspirin intake time and to evaluate the appropriate aspirin intake time by meta analysis. Methods The Cochrane Library, Medline and EMBASE were searched up to November 2018. Data were extracted formean systolic and diastolic blood pressure, platelet activity and platelet aggregation rate, changes in ADP values and the incidence of adverse reactions after taking aspirin at different times. The software RevMan 5.3 was used for data analysis. The effect scale of econometric data is expressed by weighted difference (MD) and its 95%CI. The effect scale of counting data is expressed as Odds ratio (OR) and its 95%CI. Results 80 articles were retrieved and 15 articles were included. Meta-analysis results showed there was no significant difference in systolic blood pressure between taking aspirin in the morning and at bedtime(MD=1.57, 95%CI:-0.34~3.48), taking aspirin at bedtime will lead to lower diastolic pressure than in the moming(MD=6.28,95%CI: 0.18~3.94).Taking aspirin at bedtime significantly reduced platelet activity (MD=21.08, 95%CI:9.73~32.44),but there was no significant difference in platelet aggregation rate(MD=-0.17, 95%CI:-5.66~5.32).The incidence of adverse effects of taking low-dose aspirin enteric-coated tablets before meal was lower than that after meal(OR=0.18,95%CI:0.09-0.35). Conclusion For patients with cardiovascular disease, taking small doses of aspirin at bedtime is more effective than taking it in the morning, reducing platelet activity and, to some extent, lowering blood pressure. Taking Low-dose aspirin enteric-coated tablets before meals had a lower incidence of adverse effects than that after meals.
作者
林杉
阿力木江
陈奇英
施海明
罗心平
孙韬
LIN Shan;ALI Mu-jiang;CHEN Qi-ying;SHI Hai-ming;LUO Xin-ping;SUN Tao(Hauoashan Hospital, Department of Cardiology, Fudan University, Shanghai,200040)
出处
《中国分子心脏病学杂志》
CAS
2019年第3期2878-2882,共5页
Molecular Cardiology of China
关键词
阿司匹林
服药时间
时间依从性
心血管疾病
Aspirin
Intake time
Time-dependent effect
Cardiovascular disease
