替格瑞洛联合替罗非班用于中国急性冠脉综合征患者经皮冠状动脉介入术后的系统评价

Systematically evaluate of ticagrelor combined with tirofiban in acute coronary syndrome patients after percutaneous coronary intervention in China

目的系统评价替格瑞洛联用替罗非班用于中国急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)的有效性和安全性,为临床治疗提供循证医学证据。方法检索中国学术期刊全文数据库(CNKI)、万方数据库(Wanfang Data)、维普中文期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMBmbase、The Cochrance Library数据库,检索时间均为建库至2020年12月,搜集替格瑞洛联合替罗非班用于中国ACS患者PCI术后的临床随机对照试验(RCT)。提取资料并采用改良Jadad量表评价质量,采用RevMan 5.3软件进行Meta分析。结果纳入17篇RCTs,1974例患者。Meta分析结果显示,与对照组比较,替格瑞洛联用替罗非班组患者主要不良心血管事件(MACE)[RR=0.28,95%CI=(0.21,0.37),P<0.01]、血小板聚集率[MD=-6.91,95%CI=(-8.35,-5.46),P<0.01]显著减少,左心室射血分数(LVEF)[MD=6.05,95%CI=(5.39,6.71),P<0.01]和术后血流TIMI分级3级率[RR=1.18,95%CI=(1.12,1.25),P<0.01]显著增加,同时出血发生率[RR=1.18,95%CI=(0.86,1.61),P=0.30]未明显增加。结论替格瑞洛诺联合替罗非班用于中国ACS患者PCI术后的有效性优于替格瑞洛、替罗非班单用及氯吡格雷联用替罗非班,且并未增加出血发生率。

Objective To systematically evaluate of the efficacy and safety of ticagrelor combined with tirofiban in acute coronary syndrome(ACS)patients after percutaneous coronary intervention(PCI)in China,to provide evidence-based medicine for clinical treatment.Methods The randomized controlled trials(RCT)about ticagrelor combined with tirofiban in ACS patients after PCI in China in databases of CNKI,VIP,CBM,Wanfang,PubMed,EMBmbase,and The Cochrance Library were collected from the establishment of the database to December 2020.The data extraction and quality evaluation with modified Jadad scale,Metaanalysis was performed by using RevMan 5.3 software.Results A total of 17 RCTs with 1974 patients were enrolled.Meta-analysis showed that compared with the control group,the ticagrelor combined with tirofiban had the reduced incidences of major adverse cardiac events(MACE)[RR=0.28,95%CI=(0.21,0.37),P<0.01]and platelet aggregation rate[MD=-6.91,95%CI=(-8.35,-5.46),P<0.01],significant increase left ventricular ejection fraction(LVEF)[MD=6.05,95%CI=(5.39,6.71),P<0.01]and postoperative blood flow TIMI grade 3[RR=1.18,95%CI=(1.12,1.25),P<0.01],meanwhile did not significantly increase the incidence of bleeding[RR=1.18,95%CI=(0.86,1.61),P=0.30].Conclusion The effectiveness of ticagrelor combined with tirofiban in Chinese ACS patients after PCI is better than that of ticagrelor,tirofiban and clopidogrel combined with tirofiban,and not increase the incidence of bleeding.