延长双重抗血小板治疗时间对冠心病患者疗效和安全性的Meta分析

The Meta analysis of the efficacy and safety of longer dual antiplatelet therapy in patients with coronary heart disease

目的 比较短期与长期双重抗血小板治疗对冠心病患者的疗效和安全性.方法 计算机检索PubMed、Cochrane Central Register of Controlled Trials、中国生物医学文献数据库、CNKI全文数据库,收集2001年1月至2014年6月公开发表的有关短期双重抗血小板治疗和长期双重抗血小板治疗疗效比较的随机对照试验（RCTs）,手工检索已获文献的参考文献、会议摘要及相关网站.对文献质量进行严格评价后,对符合要求的RCTs进行资料提取,并采用RevMan5.0软件进行Meta分析.结果 共纳入5项RCTs.Meta分析显示,短期和长期双重抗血小板治疗组全因死亡率（0R=0.87,95％CI 0.65～1.17,P=0.36）、心肌梗死发生率（OR=1.04,95％CI 0.73～1.48,P=0.84）、支架内血栓发生率（OR=1.23,95％CI 0.70～2.17,P=0.47）、再血管化发生率（OR =0.94,95％CI 0.71～1.25,P=0.68）、心源性死亡（OR =0.96,95％CI 0.62～1.48,P=0.84）、脑卒中发生率（OR =0.66,95％CI 0.40～1.07,P=0.09）均未见统计学差异;短期双重抗血小板治疗组大出血发生率（OR=0.48,95％CI 0.25～0.93,P=0.03）低于长期双重抗血小板治疗组.结论 在冠心病双重抗血小板治疗中,短期和长期双重抗血小板治疗的全因死亡率、心肌梗死发生率、支架内血栓发生率、再血管化发生率、心源性死亡、脑卒中发生率相似,短期双重抗血小板治疗有更低的大出血发生率,初步显示了短期双重抗血小板治疗安全性的优越.

Objective To compare the efficacy and safety of short and long dual antiplatelet therapy in patients with coronary heart disease （CHD）. Methods The databases of PubMed, Cochrane Central Register of Controlled Trials, CBM and CNKI were retrieved with computers for collecting randomized controlled trlals（RCTs） about the comparison in the efficacy and safety of short and long dual antiplatelet therapy published from Jan 2001 to Jun 2014. At the same time, the reference materials of included literature were retrieved manually. After rigor- ous evaluation on literature quality, the eligible data of RCTs was extracted and given a Meta-analysis by applying RevMan5.0 software. Results There were totally 5 RCTs includedand the results of Meta-analysis showedbetween short and long dual antiplatelet therapy groups, the incidence of all cause death（OR=0.87, 95%C1 0.65-1.17, P= 0.36）, and the incidence of myocardial infarction （OR=1.04, 95%CI 0.73-1.48, P=0.84）, the incidence of stent thrombosis （ OR = 1.23, 95%CI 0.70-2.17, P=-0.47 ）, the incidence of revascularization （ OR =0.94, 95%CI 0.71-1.25, P=0.68）, the incidence of cardiovascular death （0R=0.96, 95%1 0.62-1.48, P=0.84）, the incidence of stroke （0R=0.66, 95%CI 0.40-1.07, P=0.09） all had no significant difference, the incidence of major bleeding （0R=0.48, 95%CI 0.25-0.93, P=0.03） was lower in short group than that in long group. Conehmion In the treatment of CHD with dual antiplatelet, short an long dual antiplatelet therapy is similar in the rate of all cause death, myocardial infarction, stent thrombosis, revascularization, cardiovascular death, stroke, short dual an- tiplatelet therapy can significantly reduce the incidence of major bleeding. Preliminary shows the advantages of short dual antiplatelet therapy in coronary heart disease oatients.