阿司匹林对糖尿病患者心血管事件的Meta分析

Meta-ANALYSIS OF ASPIRIN IN PRIMARY PREVENTION OF CARDIOVASCULAR EVENTS IN PATIENTS WITH DIABETES

目的探讨阿司匹林（acetylsalicylic acid,ASA）对糖尿病（Diabetes Mellitus,DM）患者心血管事件（Cardiovascular events,CVD）一级预防的疗效及安全性。方法检索Pub Med、Cochrane Library、CNKI、VIP建库至2014年4月间的有关文献,根据纳入和排除标准收集有关ASA预防DM患者CVD的随机对照试验（randomized controlled trials,RCTs）的文献资料,评价随访期内ASA组和安慰剂/空白对照DM患者CVD发生的情况及ASA严重不良反应的种类和发生情况。运用RevMan5.2软件进行Meta分析。结果共纳入7篇RCT文献,包括6296例DM患者,其中ASA组3164例,对照组3132例。Meta分析结果显示,与对照组相比较,ASA可减少CVD的发生（RR=0.78,95%,95%CI为0.62-0.99）,尤其可减少卒中事件的发生（RR=0.71,95%,95%CI为0.55-0.93）;并且ASA并未增加胃肠道出血的风险（RR=1.98,95%CI为0.77-5.10）。但是ASA组与对照组在心肌梗死数（RR=1.04,95%CI为0.80-1.34）、心血管所致死亡数（RR=0.84,95%CI为0.36-1.94）、全死因死亡数（RR=0.87,95%CI为0.47-1.61）的比较上无统计学差异。结论本研究结果提示ASA可减少DM患者CVD的风险,患者使用小剂量阿司匹林耐受性较好,不良反应较少。

Objective To assess the efficacy and safety of Aspirin（ ASA） for primary prevention of cardiovascular events（ CVD） in diabetic patients. Methods Publications from very beginning to April 2014 of Pub Med,Cochrane Library,CNKI,VIP databases were retrieved. Publications of randomized controlled trials about ASA in prevention of cardiovascular events in patients with diabetic were collected according to the inclusion and exclusion criteria. Assessing the incidence of CVD and serious adverse reactions in aspirin group compared with placebo group（ including blank control）. And the extracteddata were calculated with Review manager 5. 2statistical software. Results Seven publications of RCT trails met to the inclusion criteria,which involved 6296 participants with diabetes mellitus（ DM）. Of which,3164 cases in ASA group,3132 cases in the control group. Meta- analysis results indicated that aspirincould reduce the total cardiovascular events comparing with placebo treatment（ RR = 0. 78,95% CI 0. 62 to0. 99）,especiallydecrease the stoke events（ RR = 0. 71,95% CI 0. 55 to 0. 93）. Meanwhile,aspirin did not increase the risk of gastrointestinal bleeding（ RR = 1. 98,95% CI 0. 77 to 5. 10）. However,no statistical significanceswerefound between the aspirin group and the control group in myocardial infarction（ RR = 1. 04,95% CI 0. 80 to 1. 34）,cardiovascular mortality（ RR = 0. 84,95% CI0. 36 to 1. 94） and all- cause mortality（ RR = 0. 87,95% CI 0. 47 to 1.61）. Conclusions Our meta- analysis results have implied that aspirin can be an alternative option for preventing the cardiovascular complications of DM. At the same time,low- dose Aspirin has little side effects and good tolerance.