质子泵抑制剂对PCI术后患者服用氯吡格雷疗效影响的Meta分析

目的系统评价质子泵抑制剂(PPI)对经皮冠状动脉介入治疗(PCI)术后患者服用氯吡格雷疗效的影响。方法按照系统评价的要求全面检索Cochrane图书馆、PubMed、Embase数据库、中文生物医学文献数据库、中国期刊全文数据库,Jadad法对纳入文献进行质量评价,应用Stata 11.0软件对1980至201 1年PPI与氯吡格雷联用对PCI术后治疗患者远期心血管事件的临床研究文献进行Meta分析。结果共检索出115篇文献,符合标准的11篇文献进入Meta分析,研究分析发现纳入文献可能存在异质性,采用随机模型进行分析,PCI术后患者联合服用PPI和氯吡格雷后心血管事件发生率显著增加[RR=1.37,95%CI(1.22,1.54),P<0.01]。纳入文献可能存在异质性,但经过各研究影响力分析合并结果可信。结论从现有的调查研究结果证据来看,联合应用PPI与氯吡格雷可使冠心病PCI术后患者再次发生心血管不良事件的风险增加,建议临床医师应谨慎选择联合用药。

Effects of proton pump inhibitors on cardiovascular outcomes in patients taking clopidogrel after PCI:a Meta-analysis

AIM To evaluate the effects of proton pump inhibitors(PPI) on cardiovascular outcomes in patients taking clopidogrel after PCI.METHODS The studies of PPI exposure in patients taking clopidogrel were searched in PubMed,Medline,Embase,CNKI,CBM,from 1980 to 2011 in any language.The quality of included trials was evaluated by Jadad scale.Meta-analysis was performed using State 11.0 for the studies relevant to the risk of cardiovascular events with PPI exposure in patients taking clopidogrel.RESULTS There were 115 trials be searched in this study.Eleven studies were included in the analysis.The 95%CI horizontal line of incorporation relative ratio dropped to the left side of the vertical line(RR = 1.37,95%CI(1.22,1.54), P<0.01),indicating the border of association.Test for heterogeneity showed that all studies had clinical heterogeneity,which allowed using random effect model analysis.Publication bias analysis showed that the funnel plot was symmetrical.The influence of individual studie analysis show the conclusion was credible. CONCLUSION As there are conficting and inconsistent data regarding the adverse clopidogrel-PPI interaction, clinicians should focus on potential harm from ulcers / haemorrhage before deciding to omit PPI in patients taking clopidogrel.