氯吡格雷联用质子泵抑制剂对心血管事件影响的Meta分析

Meta analysis:effects of clopidogrel coupled proton pump inhibitors on cardiovascular events in patients

目的评估氯吡格雷联用质子泵抑制剂是否对心血管事件存在影响,以期对临床医师用药提供一些帮助。方法计算机检索PubMed/MEDLINE,Cochrane library,EMbase,Elsevier,EBSCO,OVID,Springer Link,Webof Knowledge等数据库,以及国内各种文献数据库。运用RevMan 4.2软件进行meta分析。结果共检出140篇氯吡格雷联用质子泵抑制剂与心血管事件相关的文献,根据纳入标准最终确定12篇文献入选,共计106 403例患者。分析结果显示氯吡格雷联用质子泵抑制剂与单用氯吡格雷相比,主要负性心血管事件的发生率有所增加(RR=1.38,95%CI=1.30～1.47);服用质子泵抑制剂后心肌梗死及靶病变血运重建的发生率也比未服用者高(分别为RR=1.54,95%CI=1.11～2.14和RR=1.25,95%CI=1.13～1.37);而二者在全因病死率方面比较差异也有统计学意义(RR=2.11,95%CI=1.03～4.30)。并且相关研究结合理论分析,兰索拉唑联用氯吡格雷对负性心血管事件的发生影响最高,其次为奥美拉唑,埃索美拉唑和雷贝拉唑,最后为泮托拉唑。结论氯吡格雷联用质子泵抑制剂后会增加某些心血管负性事件的发生率,因此在联合使用时应当权衡利弊,尽可能避免相关负性事件的发生。

Objective To assess the effects of clopidogrel coupled proton pump inhibitors on cardiovascular events in patients for clinicians in better decision of treatment. Methods We searched the electronic databases（PubMed/MEDLINE,Cochrane library,EMbase,Elsevier,EBSCO,OVID,Springer Link,Web of Knowledge and some database of China）.Statistical analysis was performed by using RevMan 4.2 software. Results A total 140 studies concerning the effects of clopidogrel coupled proton pump inhibitors on cardiovascular events in patients were collected.Twelve cohort studies were included on 106 403 patients qualified for the meta-analysis according to our criteria.The results of meta-analysis showed the incidence of major adverse cardiovascular events was higher（RR=1.38,95%CI=1.30-1.47） in patients receiving clopidogrel and proton pump inhibitors compared with clopidogrel only.The incidence of myocardial infarction and target lesion revascularization were also higher in patients receiving clopidogrel and proton pump inhibitors（respectively RR=1.54,95%CI=1.11-2.14 and RR=1.25,95%CI=1.13-1.37）.Two groups had obvious differences in all-cause mortality,also（RR=2.11,95%CI=1.03-4.30）.According to the study and theories,the risk of lansoprazole coupled clopidogrel on major adverse cardiovascular events in patients was the highest.The risk of omeprazole,esomeprazole and rabeprazole was the second highest in all PPIs.The risk of pantoprazole was the lowest. Conclusion The incidents of some cardiovascular events are higher in patients receiving clopidogrel and proton pump inhibitors.So,clinicians should take into account the conditions of patients before using clopidogrel and proton pump inhibitors.