慢性肾病患者预防性使用低剂量阿司匹林有效性和安全性的Meta分析
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篇名: 慢性肾病患者预防性使用低剂量阿司匹林有效性和安全性的Meta分析
TITLE: Meta-analysis of the Efficacy and Safety of Prophylactic Use of Low-dose Aspirin in Patients with Chronic Renal Disease
摘要: 目的:评价慢性肾病患者预防性使用低剂量阿司匹林的有效性和安全性,为其临床合理使用提供循证参考。方法:通过计算机检索PubMed、Embase、Cochrane图书馆、中国知网、维普网及万方数据等数据库,检索时限均为各数据库建库起至2019年5月14日,收集预防性使用阿司匹林75~150mg/d(阿司匹林组)对比未用阿司匹林、其他抗血小板药物或使用安慰剂(对照组)的随机对照试验(RCT)研究。提取相关资料并使用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具评价质量后,采用RevMan5.3软件对慢性肾病患者的心血管事件发生率、肾脏事件发生率和出血事件发生率进行Meta分析。结果:共纳入5项RCT,合计患者4782例,其中阿司匹林组2392例、对照组2390例。Meta分析结果显示,阿司匹林组患者的心血管事件发生率[OR=0.59,95%CI(0.31,1.12),P=0.11]和肾脏事件发生率[OR=0.42,95%CI(0.08,2.23),P=0.31]与对照组比较,差异均无统计学意义;而出血事件发生率[OR=2.12,95%CI(1.23,3.66),P=0.007]显著高于对照组;排除两项较大异质性文献后,阿司匹林组患者的心血管事件发生率[OR=0.27,95%CI(0.13,0.55),P=0.0003]显著低于对照组。结论:预防性使用低剂量阿司匹林可一定程度上预防慢性肾病患者心血管事件的发生,但高出血风险的慢性肾病患者应谨慎使用。
ABSTRACT: OBJECTIVE:To evaluate the efficacy and safety of prophylactic use of low-dose aspirin in patients with chronic renal disease ,and to provide reference for evidence-based reference for rational use in the clinic. METHODS :Retrieved from PubMed,Embase,Cochrane Library ,CNKI,VIP,Wanfang database ,RCTs about prophylactic use aspirin 75-150 mg/d(aspirin group)versus no aspirin and other antiplatelet drugs or placebo (control group )were collected from inception to May 14th,2019. Relevant data were extracted. After quality evaluation with bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0,Meta-analysis of the incidence of cardiovascular events ,renal events and bleeding events in patients with chronic renal disease was performed by using Rev Man 5.3 software. RESULTS :A total of 5 RCTs were included ,involving 4 728 patients;among them ,there were 2 392 persons in aspirin group and 2 390 persons in control group. Results of Meta-analysis showed that there was no statistical significance in the incidence of cardiovascular events [OR =0.59,95%CI(0.13,1.12),P=0.11] and the incidence of renal events [OR =0.42,95%CI(0.08,2.23),P=0.31] between aspirin group and control group. The incidence of bleeding events [OR =2.12,95%CI(1.23,3.66),P=0.007] in aspirin group was significantly higher than control group. After exculsion of two heterogeneity literatures ,the incidence of cardiovascular events [OR =0.27,95%CI(0.13,0.55),P=0.000 3] in aspirin group was significantly lower than control group. CONCLUSIONS :Prophylactic use of low-dose aspirin can prevent cardiovascular events in patients with chronic renal disease to certain extent. The low-dose aspirin should be used carefully to prevent cardiovascular events in chronic renal disease patients with high risk of bleeding.
期刊: 2020年第31卷第12期
作者: 邱莎,王娜,向静,钱妍
AUTHORS: QIU Sha ,WANG Na ,XIANG Jing ,QIAN Yan
关键字: 阿司匹林;低剂量;慢性肾病;心血管事件;预防性使用;Meta分析
KEYWORDS: Aspirin;Low-dose;Chronic renal disease;Cardiovascular events ;Prophylactic use ;Meta-analysis
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