替格瑞洛对比氯吡格雷治疗急性冠状动脉综合征有效性与安全性的Meta分析
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篇名: 替格瑞洛对比氯吡格雷治疗急性冠状动脉综合征有效性与安全性的Meta分析
TITLE:
摘要: 目的:系统评价替格瑞洛对比氯吡格雷治疗急性冠状动脉综合征(ACS)的有效性和安全性,旨在为临床用药提供循证参考。方法:计算机检索PubMed、Embase、Cochrane图书馆、中国生物医学文献光盘数据库、中国期刊全文数据库等,收集替格瑞洛(试验组)对比氯吡格雷(对照组)治疗ACS的随机对照试验(RCT)。筛选文献、提取资料并采用改良Jadad量表评价质量后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入26项RCT,合计8 560例患者。Meta分析结果显示,试验组患者主要不良心脏事件发生率[RR=0.47,95%CI(0.38,0.57),P<0.000 01]、脑卒中发生率[RR=0.24,95%CI(0.08,0.69),P=0.008]、血小板聚集率[SMD=-3.16,95%CI(-4.16,-2.16),P<0.000 01]、C反应蛋白水平[SMD=-1.02,95%CI(-1.76,-0.29),P=0.006]均显著低于对照组,尿酸水平[SMD=0.64,95%CI(0.39,0.88),P<0.000 01]显著高于对照组;两组患者主要出血事件发生率[RR=0.96,95%CI(0.66,1.40),P=0.85]、呼吸困难发生率[RR=1.19,95%CI(0.78,1.80),P=0.42]比较,差异均无统计学意义。结论:替格瑞洛治疗ACS的疗效和安全性均优于氯吡格雷,但可引起尿酸升高。
ABSTRACT: OBJECTIVE: To systematically evaluate the efficacy and safety of ticagrelor versus clopidogrel in the treatment of acute coronary syndrome (ACS). METHODS: Retrieved from PubMed, Embase, Cochrane Library, CBM and CNKI, randomized controlled trials (RCTs) about ticagrelor (trial group) and clopidogrel (control group) in the treatment of ACS were included. After literature screening, data extraction and quality evaluation with modified Jadad scale, Meta-analysis was performed by using Rev Man 5.3 software. RESULTS: 26 RCTs were included, involving 8 560 patients. Meta-analysis showed that the incidence of main adverse cardiac event [RR=0.47,95%CI(0.38,0.57),P<0.000 01] and stroke [RR=0.24,95%CI(0.08,0.69),P=0.008], platelet aggregation rate [SMD=-3.16,95%CI(-4.16,-2.16),P<0.000 01] and C-reactive protein level [SMD=-1.02,95%CI(-1.76,-0.29),P=0.006] in trial group were significantly lower than control group; uric acid level [SMD=0.64,95%CI(0.39,0.88),P<0.000 01] of trial group was significantly higher than control group. There was no statistical significance in the incidence of main bleeding event [RR=0.96,95%CI(0.66,1.40),P=0.85] or dyspnea [RR=1.19,95%CI(0.78,1.80),P=0.42] between 2 groups. CONCLUSIONS: The efficacy and safety of ticagrelor is superior to those of clopidogrel in treatment of ACS, but ticagrelor can cause the elevation of uric acid.
期刊: 2019年第30卷第12期
作者: 姚斌,李国武,刘瑞,雷鸣
AUTHORS: YAO Bin,LI Guowu,LIU Rui,LEI Ming
关键字: 替格瑞洛;氯吡格雷;急性冠脉综合征;疗效;安全性;Meta分析
KEYWORDS: Ticagrelor; Clopidogrel; Acute coronary syndrome; Efficacy; Safety; Meta-analysis
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