不同质子泵抑制剂与抗血小板药物联用时心血管安全性Meta分析

Safety of antiplatelet drugs-proton pump inhibitors combination therapy in cardiovascular events:a systematic review

背景与目的:药理学研究表明,抗血小板药物,尤其是氯吡格雷,与质子泵抑制剂存在着竞争性抑制作用。本研究旨在系统性分析临床中不同质子泵抑制剂与抗血小板药物联用时心血管事件的发生风险。方法:计算机检索Cochrane图书馆、PubMed、EMbase、Elsevier、Web of science等数据库,检索时间从2010年1月至2012年9月,对符合纳入标准的文献进行检索并追踪已获文献的参考文献,采用RevMan 5.0软件进行Meta分析。结果:共纳入14篇文献,合计67 131例患者。Meta分析结果显示,使用奥美拉唑有增加心血管事件发生的风险[RR=1.32,95%CI(1.01,1.71)];使用雷贝拉唑有增加心血管事件发生的风险[RR=1.57,95%CI(1.12,2.19)];使用兰索拉唑不增加心血管事件发生风险[RR=1.11,95%CI(0.93,1.32)];使用埃索美拉唑不增加心血管事件发生风险[RR=1.24,95%CI(0.91,1.68)];使用泮托拉唑不增加心血管事件发生风险[RR=1.34,95%CI(0.93,1.92)]。结论:奥美拉唑或雷贝拉唑与抗血小板药物联用时会增加心血管事件发生风险,而泮托拉唑、埃索美拉唑及兰索拉唑与抗血小板药物联用时不会增加心血管事件发生风险。

Background and Objective： Data from pharmacokinetic and pharmacodynamic studies indicate that the adverse interaction between antiplatelet drugs,especially clopidogrel,and proton pump inhibitor （PPI） may vary among PPIs.We aimed to evaluate systematically whether individual PPIs differ in their risk for cardiovascular events when concomitantly administered with antiplatelet drugs. Methods： Such databases as the Cochrane Library,PubMed、EMbase、Elsevier and Web of science were searched during January 2010 through September 2012.The bibliographies of the retrieved articles were also checked.The RevMan 5.0 soft ware was used for meta-analyses. Results： A total of 14 studies with 67131 participants were included.The results of meta-analyses showed that： 1） the use of antiplatelet drugs combined with omeprazole was associated with increasing the risk of cardiovascular events[RR=1.32,95%CI=（1.01,1.71）]; 2） the use of antiplatelet drugs combined with rabeprazole was associated with increasing the risk of cardiovascular events[RR=1.57,95%CI（1.12,2.19）]; 3）There was no enough evidence to reach the conclusion that the combination use with lansoprazole could increase the risk of cardiovascular events[RR=1.11,95%CI（0.93,1.32）]; 4）the use of antiplatelet drugs combined with esomeprazole wasn＇t associated with the increasing risk of cardiovascular events[RR=1.24,95%CI（0.91,1.68）]; 5） the use of antiplatelet drugs combined with pantoprazole wasn＇t associated with increasing the risk of cardiovascular events[RR=1.34,95%CI（0.93,1.92）]. Conclusion： Omeprazole or Rabeprazole combined with antiplatelet drugs may increase the risk of incident cardiovascular events.However,Pantoprazole,Esomeprazole and Lansoprazole does not increase the risk of incident cardiovascular events when combined with antiplatelet drugs.