西洛他唑三联疗法治疗PCI后再狭窄效果的Meta分析

目的系统评价西洛他唑三联疗法（西洛他唑＋阿司匹林＋氯吡格雷）治疗PCI后再狭窄的有效性和安全性。方法计算机检索Cochrane Library（2009年第3期）、PubMed（1966～2009）、EMbase（1974～2009）、CNKI（1994～2009）、CMB（1978～2009.2）、VIP（1989～2009.2）和中华医学会数字化期刊库（1998～2009）。由2名评价者按纳入与排除标准独立选择试验、评价质量并交叉核对,而后对同质研究采用RevMan 5.0软件进行Meta分析。结果共纳入5个RCT,包括2？348例患者。Meta分析结果显示：与二联疗法（阿司匹林＋氯比格雷）比较,西洛他唑三联疗法可以增加术后最小腔内直径MD=0.31,95%CI（0.11,0.51）],降低再狭窄率OR=0.49,95%CI（0.37,0.65）]和病死率OR=0.52,95%CI（0.31,0.88）];但在靶血管血运重建、中风和心悸发生率及主要不良心脑血管事件和心血管事件发生率方面,西洛他唑三联疗法和二联疗法之间并无明显差异。结论目前的研究证据显示,基于西洛他唑的三联疗法可以降低再狭窄的发生率,增加术后最小腔内直径,且能降低病死率,值得临床推广应用。

Effectiveness and Safety of Cilostazol for Restenosis after Percutaneous Coronary Intervention: A Meta-Analysis

Objective To evaluate the clinical efficacy and safety of triple-antiplatelet treatment based on Cilostazol for restenosis after percutaneous coronary intervention.Methods We searched the Cochrane Central Register of Controlled Trials（CENTRAL,The Cochrane Library,Issue 3,2009）,PubMed（1966 to 2009）,EMbase（1974 to 2009）,CNKI（1994 to 2009）,CBM（1978 to Feb.2009）,VIP（1989 to Feb.2009）,and CMD Digital Periodicals（1998 to 2009）.Two reviewers independently evaluated the quality of the included studies and extracted the data.Meta-analyses were performed using RevMan 5.0 software.Results Five randomized controlled trials（RCTs）involving 2 348 patients were included.The results of meta-analyses showed that triple-antiplatelet treatment based on Cilostazol could increase minimum lumen diameter（MD=0.31,95%CI 0.11 to 0.51）and decrease restenosis rate（OR=0.49,95%CI 0.37 to 0.65）.In addition,it could decrease death rate（OR=0.52,95%CI 0.31 to 0.88）,but it could not change target-vessel revascularization,stroke rate,palpitation rate,and the rate of major adverse cardiac and cerebral events and major adverse cardiac events.Conclusion Evidence shows that triple-antiplatelet treatment based on Cilostazol could increase minimum lumen diameter and decrease restenosis rate and death rate.Their clinical application is worthy to be advocated.