基于Meta分析的替格瑞洛联合瑞舒伐他汀治疗不稳定型心绞痛的疗效和安全性评价

Meta-Analysis of Efficacy and Safety of Ticagrelor Combined with Rosuvastatin Therapy in the Treatment of Unstable Angina Pectoris

目的:基于Meta分析,系统评价替格瑞洛联合瑞舒伐他汀治疗不稳定型心绞痛(UAP)的疗效和安全性。方法:计算机检索PubMed、the Cochrane Library、Embase、中国知网、万方数据库及维普数据库,检索时限为建库至2020年9月,筛选有关替格瑞洛联合瑞舒伐他汀治疗UAP的临床随机对照试验(RCT,在常规治疗基础上,研究组患者使用替格瑞洛联合瑞舒伐他汀治疗,对照组患者使用氯吡格雷联合瑞舒伐他汀治疗)。根据纳入和排除标准选取文献、提取数据并进行质量评价,运用RevMan 5.3软件进行Meta分析。结果:共纳入12项RCT,涉及患者1 220例。Meta分析结果显示,与氯吡格雷联合瑞舒伐他汀相比,替格瑞洛联合瑞舒伐他汀治疗UAP患者可明显提高临床总有效率(RR=1.26,95%CI=1.19~1.33,P<0.000 01)及高密度脂蛋白胆固醇水平(MD=0.43,95%CI=0.23~0.63,P<0.000 1),降低总胆固醇水平(MD=-0.92,95%CI=-1.12~-0.72,P<0.000 01)、三酰甘油水平(MD=-0.75,95%CI=-0.89~-0.61,P<0.000 01)、低密度脂蛋白胆固醇水平(MD=-0.85,95%CI=-1.06~-0.65,P<0.000 01)及超敏C反应蛋白水平(MD=-2.33,95%CI=-2.75~-1.90,P<0.000 01),减少心绞痛发作频次(MD=-2.94,95%CI=-3.47~-2.40,P<0.000 01),缩短心绞痛发作持续时间(SMD=-2.35,95%CI=-3.35~-1.35,P<0.000 01),差异均有统计学意义;两组患者不良反应发生率比较,差异无统计学意义(RR=0.59,95%CI=0.33~1.04,P=0.07)。结论:当前证据表明,替格瑞洛联合瑞舒伐他汀治疗UAP在总有效率及各项临床指标等方面均明显优于氯吡格雷联合瑞舒伐他汀,且安全性与氯吡格雷联合瑞舒伐他汀相当。

OBJECTIVE: To systematically evaluate the efficacy and safety of ticagrelor combined with rosuvastatin in the treatment of unstable angina pectoris(UAP). METHODS: PubMed, the Cochrane Library, Embase, CNKI, Wanfang Data and VIP database were electronically retrieved to collect clinical randomized controlled trial(RCT) of ticagrelor combined with rosuvastatin in the treatment of unstable angina pectoris(on the basis of conventional treatment, the study group was treated with ticagrelor combined with rosuvastatin, while the control group received clopidogrel combined with rosuvastatin),the retrieval time limit is from the establishment of the database to Sept. 2020. According to the inclusion and exclusion criteria, literature were selected, data were extracted and quality was evaluated. RevMan 5.3 software was used for Meta-analysis. RESULTS: Totally 12 RCT were enrolled, including 1 220 patients. Meta-analysis showed that compared with clopidogrel combined with rosuvastatin, ticagrelor combined with rosuvastatin could significantly improve the total clinical effective rate(RR=1.26,95%CI=1.19-1.33,P<0.000 01) and the level of high density lipoprotein cholesterol(MD=0.43,95%CI=0.23-0.63,P<0.000 1), decrease the total cholesterol level(MD=-0.92,95%CI=-1.12--0.72,P<0.000 01), triglyceride level(MD=-0.75,95%CI=-0.89--0.61,P<0.000 01), low density lipoprotein cholesterol level(MD=-0.85,95%CI=-1.06--0.65,P<0.000 01) and high sensitivity C-reactive protein(MD=-2.33,95%CI=-2.75--1.90,P<0.000 01), decrease the frequency of angina pectoris(MD=-2.94,95%CI=-3.47--2.40,P<0.000 01), shorten the duration of angina pectoris(SMD=-2.35,95%CI=-3.35--1.35,P<0.000 01), with statistically significant differences. There was no statistically significant difference in the incidence of adverse drug reactions between two groups(RR=0.59,95%CI=0.33-1.04,P=0.07). CONCLUSIONS: Current evidence shows that ticagrelor combined with rosuvastatin in the treatment of UAP is significantly better than clopidogrel combined with rosuvastatin in terms of total effective rate and various clinical indicators, and the safety is similar to that of clopidogrel combined with rosuvastatin.