不同代谢途径他汀类药物联用氯吡格雷对急性冠脉综合征患者血小板功能影响的Meta分析

Effects of Different Statins Combined with Clopidogrel on the Platelet Functions in Patients with Acute Coronary Syndrome:A Meta Analysis

目的对不同代谢途径他汀类药物联用氯吡格雷对急性冠脉综合征患者血小板功能和主要不良事件的影响进行系统评价。方法检索PubMed、EMBASE、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊、万方数字化期刊群自创建至2011年6月发表的关于不同代谢途径他汀类药物联用氯吡格雷对急性冠脉综合征患者血小板功能影响的文献,并追踪已获文献的参考文献。由2名研究者独立进行质量评价和数据提取。采用RevMan4.2.8软件进行Meta分析。结果共纳入11项随机对照研究,共计1923例患者。Meta分析结果显示,不同代谢途径他汀类药物与氯吡格雷联用对急性冠脉综合征患者住院期间血小板聚集率的影响没有显著性差异(加权均数差0.39,95%可信区间-1.84～2.62,P=0.73),而接受经CYP3A4代谢的他汀类药物与氯吡格雷联用治疗的急性冠脉综合征患者P-选择素水平较低(加权均数差-1.16,95%可信区间-1.77～-0.54,P=0.0002),接受不同代谢途径的他汀类药物与氯吡格雷联用时,急性冠脉综合征患者1个月内的主要不良心脏事件发生率没有显著性差异(比值比1.07,95%可信区间0.77～1.49,P=0.69)。结论不同代谢途径他汀类药物与氯吡格雷联用对急性冠脉综合征患者的血小板功能和主要不良心脏事件发生率可能无明显影响,但仍需大规模临床试验加以证实。

Objective To evaluate the effects of different statins （CYP3A4 metabolized statins and CYP2C9 metabolized statins） combined with Clopidogrcl on the platelet functions in patients with acute coronary syndrome （ACS） by meta analysis. Method Both foreign and Chinese databases including PubMed, EMBASE, Cochrane library, and CNKI were searched to identify randomized controlled trials （RCTs） that reported the effects of different statins combined with Clopidogrel on the platelet functions and major adverse cardiac events （MACE）. Two reviews assessed the quality of each trial and extracted data independently. The Cochrane Collaboration＇s RevMan 4.2.8 software was used for statistical analysis. Results A total of 11 RCTs were included, and the methodological quality of each trial was good. There was no significant difference in platelet aggregation rate when different types of statins were used（WMD--0.39, 95%CI -1.84~2.62, P=0.73）, as well as the incidence of MACE（OR--1.07, 95%CI 0.77-1.49, P=0.69）. However, the level of P-seleetin was lower in patients received CYP3A4 metabolized statins （WMD---1.16, 95%CI -1.77 -0.54, P=0.000 2）. Conclusion Both statins metabolized with and without CYP3A4 were safe for ACS patients.