替格瑞洛与氯吡格雷治疗急性冠脉综合征疗效和安全性比较的系统评价

Systematically Review on Comparison of Efficacy and Safety between Ticagrelor and Clopidogrel in Treatment of Acute Coronary Syndrome

目的:基于文献荟萃(Meta分析)方法,系统评价替格瑞洛与氯吡格雷治疗急性冠脉综合征的疗效和安全性。方法:计算机检索MEDLINE、EMBase、中国知网、中文生物医学文献数据库、万方数据库(时限为2007年1月至2019年2月),全面收集有关替格瑞洛与氯吡格雷治疗急性冠脉综合征的随机对照研究(替格瑞洛组的干预措施为予以常规剂量或负荷剂量的替格瑞洛;氯吡格雷组的干预措施为予以常规剂量或负荷剂量的氯吡格雷),排除动物实验研究。对纳入的研究进行严格的质量评价后,采用RevMan 5.1软件进行Meta分析。结果:最终纳入28篇文献(英文文献3篇,中文文献25篇),共6139例受试者。Meta分析结果显示,替格瑞洛组患者不良心脏事件发生率(OR=0.44,95%CI=0.34~0.57,P<0.00001)、死亡发生率(OR=0.41,95%CI=0.24~0.72,P=0.002)、心肌梗死发生率(OR=0.35,95%CI=0.19~0.65,P=0.0009)明显低于氯吡格雷组,差异均有统计学意义;替格瑞洛组患者呼吸困难发生率明显高于氯吡格雷组(OR=3.86,95%CI=1.95~7.61,P<0.0001),差异有统计学意义;两组患者出血事件发生率(OR=1.10,95%CI=0.82~1.48,P=0.51)、脑卒中发生率(OR=0.96,95%CI=0.36~2.55,P=0.94)的差异均无统计学意义。结论:与氯吡格雷相比,替格瑞洛可显著降低急性冠脉综合征患者的不良心血管事件发生率、死亡发生率和心肌梗死发生率,对脑卒中和出血事件发生率的影响与氯吡格雷相当,但可致呼吸困难发生率升高。

OBJECTIVE:To systematically evaluate the efficacy and safety of ticagrelor and clopidogrel in treatment with acute coronary syndrome(ACS)based on Meta-anlysis.Methods:Randomized controlled trials about ticagrelor and clopidogrel in treatment with ACS(intervention in ticagrelor group was given conventional dose or loading dose of ticagrelor;intervention in clopidogrel group was given conventional or dosed doses of clopidogrel)were retrieved from MEDLINE,EMBase,CNKI,CBM,Wanfang(from Jan.2007 to Feb.2019),experimental studies on animals were excluded.After strict quality evaluation on involved studies,RevMan 5.1 was adopted to conduct Meta-analysis.RESULTS:A total of 28 studies were involved(3 studies were in English,25 were in Chinese),including 6139 subjects.Results of Meta analysis indicated that the incidence of major adverse cardiac events(OR=0.44,95%CI=0.34-0.57,P<0.00001),death rate(OR=0.41,95%CI=0.24-0.72,P=0.002)and incidence of myocardial infarction(OR=0.35,95%CI=0.19-0.65,P=0.0009)of ticagrelor group were significantly lower than those of clopidogrel group,with statistically significant differences;the incidence of dyspnea(OR=3.86,95%CI=1.95-7.61,P<0.0001)of ticagrelor group was significantly higher than that of clopidogrel group,with statistically significant difference;there was no statistical significance in differences of incidences of bleeding events(OR=1.10,95%CI=0.82-1.48,P=0.51)and stroke(OR=0.96,95%CI=0.36-2.55,P=0.94).CONCLUSIONS:Compared with clopidogrel,ticagrelor can significantly reduce the incidence of major adverse cardiac events,death rate and incidence of myocardial infarction in patients with ACS,while the effect on incidences of stroke and bleeding events is comparable,but can cause an increase in incidence of dyspnea.