替格瑞洛应用于急性冠状动脉综合征合并糖尿病患者经皮冠脉介入术后疗效与安全性的Meta分析

Effectiveness and safety of ticagrelor in patients with acute coronary syndrome and diabetes mellitus after percutaneous coronary intervention: A meta-analysis

目的评价替格瑞洛与氯吡格雷应用于急性冠状动脉综合征(acute coronary syndrome,ACS)合并糖尿病(diabetes mellitus,DM)患者经皮冠状动脉介入术(PCI)后的有效性与安全性。方法计算机和人工检索PubMed、Cochrane图书馆、CBM、万方数据库及中国知网等数据库收录的关于比较替格瑞洛与氯吡格雷应用于ACS合并DM患者PCI术后疗效与安全性的临床对照实验文献,检索时间为建库时间至2018年6月,根据Cochrane手册标准对纳入文献的质量予以评价。结果最终15篇文献纳入研究,包括14篇中文文献,1篇英文文献,病例总数为2 231例。结果显示,替格瑞洛组的主要心血管不良事件(major adverse cardiac events,MACE)、心肌梗死、支架内血栓形成发生率显著低于氯吡格雷组(OR=0.40,95%CI:0.29～0.53,P=0.000;OR=0.53,95%CI:0.30～0.95,P=0.034;OR=0.30,95%CI:0.16～0.56,P=0.000);两组在出血发生率方面差异无统计学意义(OR=1.23,95%CI:0.88～1.72,P=0.227);但替格瑞洛组在呼吸困难发生率方面明显高于氯吡格雷组(OR=4.2,95%CI:2.39～7.38,P=0.000)。结论与氯吡格雷相比,替格瑞洛治疗DM合并ACS的PCI术后患者,在不增加出血的风险的同时,可有效降低MACE,心肌梗死、支架内血栓形成的发生率;但呼吸困难发生率氯吡格雷低于替格瑞洛。

Objective To compare the effectiveness and safety of ticagrelor versus clopidogrel in acute coronary syndrome(ACS)combined with diabetes mellitus(DM)after percutaneous coronary intervention(PCI).Methods PubMed,Cochrane Library,CBM,Wan fang database and China National Knowledge Internet were used for searching literatures on the comparison of effectiveness and safety of ticagrelor versus clopidogrel in ACS combined with DM after PCI before June 2018.The quality of the articles was assessed according to the method of Cochrane manual standard.Results A total of 15 articles were included in this Metaanalysis,covering 2 231 patients.The results of this Meta-analysis showed that the incidences of major adverse cardiac events(MACE),myocardial infarction and stent thrombosis of ticagrelor group were lower than those of clopidogrel group(OR=0.40,95% CI : 0.29- 0.53,P=0.000;OR=0.53,95% CI : 0.30-0.95,P=0.034;OR=0.30,95% CI : 0.16-0.56,P=0.000).There was no statistically significant difference between the two groups in the incidence of bleeding events(OR=1.23,95% CI : 0.88-1.72,P=0.227).However,the incidence of dyspnea events of ticagrelor was higher than that of clopidogrel(OR=4.2,95% CI : 2.39-7.38,P=0.000).Conclusion Compared with clopidogrel,ticagrelor has obvious advantages in reducing the incidences of MACE,myocardial infarction and stent thrombosis,without improving the incidence of bleeding events,while it may increase the incidence of dyspnea events.