替格瑞洛和氯吡格雷在老年冠心病患者抗血小板治疗中有效性及安全性的Meta分析

目的：探讨替格瑞洛和氯吡格雷在老年冠心病患者抗血小板治疗中的疗效及安全性，阐明更合理的抗血小板治疗策略。方法：应用计算机检索Cochrane试验资料库、Ovid-Medline全文数据库、EMBase数据库、PubMed数据库、中国学术文献总库（CNKI）、万方数字化期刊库、维普数据库（VIP）及中国生物医学文献数据库（CBM），收集分为替格瑞洛组和氯吡格雷组治疗老年冠心病的随机对照试验（RCT），2组患者分别给予替格瑞洛联合其他药物及氯吡格雷联合其他药物治疗，应用RevMan5.3统计软件进行Meta分析，观察抗血小板治疗有效性相关不良事件[即主要心血管不良事件（MACE）、心肌梗死（MI）、支架内血栓、全因死亡及卒中]和安全性相关不良事件（出血事件）的发生情况。结果：按照纳入和排除标准，共纳入15篇符合入选标准的RCT。Meta分析，与氯吡格雷组比较，替格瑞洛组MACE发生率（RR=0.59，95% CI：0.46~0.76，Z=4.08，P<0.01）、MI发生率（RR=0.48，95% CI：0.28~0.81，Z=2.74，P=0.006）、支架内血栓发生率（RR=0.16，95% CI：0.06~0.48，Z=3.30，P=0.001）和全因死亡发生率（RR=0.52，95% CI：0.30~0.89，Z=2.41，P=0.02）均明显降低，卒中发生率（RR=0.76，95% CI：0.39~1.47，Z=0.81，P=0.42）差异无统计学意义，出血发生率（RR=1.57，95% CI：1.20~2.05，Z=3.28，P=0.001）明显增加。结论：对于老年冠心病患者，替格瑞洛抗血小板治疗的有效性优于氯吡格雷，但可增加出血发生率。

Effectiveness and securities of ticagrelor and clopidogrel in antiplatelet therapy for coronary heart disease in old people:A Meta-analysis

Objective: To explore the curative effects and securities of ticagrelor and clopidogrel in the antiplatelet therapy for coronary heart disease in the aged patients, and to provide a more rational strategy for antiplatelet therapy.Methods: Computer search was performed in Cochrane Central Register of Controlled Trial, Ovid-Medline, EMBase, PubMed, CNKI, Wanfang, VIP and CBM,and the randomized controlled trial (RCT) of ticagrelor and clopidogrel in the treatment of coronary heart disease in the old people were collected. The patients in ticagrelor group were given ticagrelor and other drugs,and the patients in clopidogrel group were given clopidogrel and other drugs. RevMan 5.3 software was used to perform Meta-analysis,and the adverse events related to the effectiveness such as the major adverse cardiovascular events(MACE),myocardial infarction(MI),stent thrombosis,death,stroke and the adverse events related to safety (bleeding event) were observed.Results: According to inclusion and exclusion criteria,a total of 15 RCT were included. The results of Meta-analysis showed that the incidences of MACE(RR=0.59,95%CI:0.46-0.76,Z=4.08,P<0.01), MI(RR=0.48,95%CI:0.28-0.81,Z=2.74,P=0.006), stent thrombosis (RR=0.16,95%CI:0.06-0.48,Z=3.30,P=0.0010),and death (RR=0.52,95%CI:0.30-0.89,Z=2.41,P=0.02) in ticagrelor group were decreased compared with clopidogrel group;there was no significant difference in stroke rate (RR=0.76,95%CI:0.39-1.47,Z=0.81,P=0.42)between two groups,and the incidence of bleeding event in ticagrelor group was increased compared with clopidogrel group(RR=1.57,95%CI:1.20-2.05,Z=3.28,P=0.001).Conclusion: For the aged patients with coronary heart disease,ticagrelor is superior to clopidogrel;but the incidence of bleeding is increased.