阿司匹林用于非终末期肾脏病心血管疾病的一级预防Meta分析

Aspirin for primary prevention of cardiovascular disease in non end stage renal disease:a Meta analysis

目的:评价阿司匹林在非终末期慢性肾脏病患者心血管疾病一级预防中的有效性和安全性。方法:计算机检索PubMed、EMbase、CENTRAL、WanFang Data、CNKI、CBM、维普数据库以及国内外临床实验注册网站,搜集阿司匹林用于心血管疾病一级预防的随机对照试验或队列研究,检索时限均从建库至2020年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入5个随机对照试验(RCT),包括21474例研究对象。Meta分析结果显示,阿司匹林可有效降低心血管事件风险,>1000例组亚组分析结果(RR=0.84,95%CI:0.73~0.96,P=0.01),<1000例组亚组分析结果(RR=0.32,95%CI:0.17~0.60,P=0.0004)。但同时增加出血风险(RR=1.97,95%CI:1.09~3.58,P=0.03)。结论:当前证据支持阿司匹林有效降低非终末期慢性肾脏病患者心血管发生事件,但增加了出血风险。对肾功能影响还需要更多的随机对照实验协助分析。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective:To evaluate the efficacy and safety of aspirin in primary prevention of cardiovascular disease in patients with non end-stage chronic kidney disease.Methods:PubMed,EMBASE,CENTRAL,Wanfang Data,Viper Data,CBM Date,CNKI databases and Clinical trial registration websites were searched for randomized controlled trials(RCTs)or cohort studies of aspirin for primary prevention of cardiovascular diseases from the establishment of the database to January 2020.Two researchers independently screened the literature,extracted the data and evaluated the risk of bias in the included study,and then used Revman 5.3 software for meta-analysis.Results:five RCTs including 21474 subjects were included.The result of meta-analysis showed that aspirin could effectively reduce the risk of cardiovascular events,which was greater than the result of subgroup analysis of 1000 persons(RR=0.84,95%CI:0.73-0.96,P=0.01),and the result of subgroup analysis of less than 1000 persons(RR=0.32,95%CI:0.17-0.60,P=0.0004).But it also increased the risk of bleeding(RR=1.97,95%CI:1.09-3.58,P=0.03).Conclusions:current evidence supports that aspirin effectively reduces cardiovascular events in patients with non-end-stage chronic kidney disease,but increases the risk of bleeding.More randomized controlled trials are needed to analyze the effect on renal function.Limited by the number and quality of the included studies,the above conclusion need to be verified by more high-quality studies.