氯吡格雷联用质子泵抑制剂对再次心血管不良事件影响的Meta分析

Clopidogrel plus proton pump inhibitors increases recurrent major adverse cardiac events： A Meta-Analysis

目的 系统评价氯吡格雷联用质子泵抑制剂对再次发生心血管不良事件（MACE）的影响,为临床用药提供参考依据.方法 通过计算机检索PubMed、MEDLINE数据库、医文网、中国生物医学文献数据库、万方数据库,使用RevMan 4.2软件对已公开发表的有关氯吡格雷单用和联用质子泵抑制剂治疗急性冠状动脉综合征（ACS）且再次心血管不良事件或再次住院患者的临床研究文献进行Meta分析.结果 共纳入8篇临床研究文献,包括51 191例患者,其中氯吡格雷联用质子泵抑制剂治疗（PPI＋Clopidogrel组）有18 618例,单用氯吡格雷治疗（Clopidogrel alone组）有32 573例.Meta分析结果显示：Clopidogrel ＋PPI组再次MACE发生率明显高于Clopidogrel alone组（OR=1.55,95%CI：1.47～1.64,P＜0.01）.敏感性分析显示该研究结果稳定性较好.结论 氯吡格雷与质子泵抑制剂联合应用可增加患者再次发生心血管不良事件和再次入院的风险.临床医生应谨慎选择联合用药,从而最大限度地降低药物不良反应和心血管不良事件的发生.

Objective To evaluate the effects of clopidogrel plus proton pump inhibitors （PPI） on recurrent major adverse cardiac events （MACE）. Methods Databases including PubMed, MEDLINE, METAMED, CBM and Wanfang were searched. Meta-Analysis was conducted with RevMan 4.2 software to analyze published clinical studies on incidence of recurrent MACE and rehospitalization in patients taking clopidogrel, with and without concomitant PPI. Results Eight studies covering 51 191 patients were included, among which 18 618 patients taking clopidogrel plus PPI, 32 573 patients taking clopidogrel alone. Result showed that the incidence of MACE in clopidogrel plus PPI group was significantly higher than that of clopidogrel alone group （OR = 1.55, 95%C1：1.47 - 1.64, P 〈 0.01）. The stability of the results was confirmed by subsequent sensitivity analysis. Conclusion Patients taking clopidogrel plus PPI have higher risk of recurrent MACE and rehospitalization.