质子泵抑制剂联合双联抗血小板对急性冠脉综合征患者经皮冠状动脉介入治疗的疗效与安全性的系统评价

Systematic evaluation of the efficacy and safety of proton pump inhibitors combined with dual anti-platelet agents in percutaneous coronary intervention in patients with acute coronary syndrome

目的:系统评价质子泵抑制剂联合双联抗血小板对急性冠脉综合征患者经皮冠状动脉介入治疗的疗效与安全性,为临床治疗决策提供最佳循证证据。方法:计算机检索Cochrane library、PubMed、EMbase、CNKI、万方、VIP数据库,检索时间自建库至2018年5月,对符合纳入标准的RCT进行资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析,并采用Stata 14软件进行Egger’s检验对发表偏倚进行定量检测。结果:共纳入11个RCT,2 313例患者。Meta分析结果显示,急性冠脉综合征经皮冠状动脉介入患者,与单纯的双联抗血小板治疗相比,双联抗血小板联用质子泵抑制剂治疗可有效降低治疗期间消化道出血事件的发生[OR=0.19, 95%CI:0.12,0.30],且未增加随访6个月内主要心血管不良事件的发生[OR=1.28, 95%CI:0.95,1.73],治疗1个月后血小板反应指数无显著性差异[MD=1.89, 95%CI:-6.30,10.09],治疗1个月后血小板聚集反应性无显著性差异[MD=-0.71, 95%CI:-4.28,2.86]。结论:质子泵抑制剂联合双联抗血小板治疗急性冠脉综合征经皮冠状动脉介入患者,与单纯的双联抗血小板治疗相比,其疗效确切,且可提高患者预后安全性。

OBJECTIVE To systematically evaluate the efficacy and safety of proton pump inhibitors combined with dual anti-platelet therapy in patients with acute coronary syndrome who underwent percutaneous coronary intervention,and to provide the best evidence-based evidence for clinical treatment decision-making.METHODS The Cochrane library,PubMed,EMbase,CNKI,Wanfang,VIP database from inception to May 2018 were searched.After data extraction and quality evaluation of RCT according to inclusion criteria,RevMan 5.3 software was used for Meta analysis,and Stata 14 software was used to perform Egger’s test to quantitatively detect publication bias.RESULTS A total of 11 RCTs with 2 313 patients were included.Meta-analysis showed that in patients with acute coronary syndrome who underwent percutaneous coronary intervention,dual antiplatelet therapy combined with proton pump inhibitor therapy was effective in reducing the occurrence of gastrointestinal bleeding events during treatment compared with dual antiplatelet therapy alone[OR=0.19,95%CI:0.12,0.30],and did not increase the occurrence of major adverse cardiovascular events within 6 months of follow-up[OR=1.28,95%CI:0.95,1.73].,There was no significant difference in platelet reactivity Index after 1 month of treatment between the two groups[MD=1.89,95%CI:-6.30,10.09],and there was no significant difference in adenosine diphosphate induced platelet aggregation after 1 month of treatment between the two groups[MD=-0.71,95%CI:-4.28,2.86].CONCLUSION Compared with dual anti-platelet therapy alone,proton pump inhibitors combined with dual anti-platelet therapy for acute coronary syndrome patients with percutaneous coronary intervention have definite efficacy and can improve the prognosis of patients.