氯吡格雷和替格瑞洛抗血小板治疗中肺炎发生风险比较的meta分析CSCD

目的比较氯吡格雷和替格瑞洛抗血小板治疗中肺炎的发生风险。方法检索PubMed、Embase、Cochrane Library、CBM、中国知网和万方医学数据库(截至2022年3月1日),收集氯吡格雷和替格瑞洛(互为试验组和对照组)治疗冠状动脉粥样硬化性心脏病的随机对照临床试验(RCT)。采用国际通用的Cochrane协作网偏倚风险评估工具进行方法学质量评价,采用RevMan5.3软件进行meta分析,比较2组患者中肺炎的发生风险,效应值为危险度(RR)及其95%置信区间(CI)。结果共纳入5项RCT,质量评价结果2项为低偏倚风险,3项为高偏倚风险。5项RCT共涉及患者36401例,适应证为急性冠状动脉综合征者18724例、外周动脉疾病13842例、心肌梗死3799例、心搏骤停昏迷36例。meta分析结果显示,氯吡格雷和替格瑞洛组肺炎发生率分别为1.5%(271/18174)和1.2%(217/18227),替格瑞洛治疗中发生肺炎的风险较氯吡格雷低,差异有统计学意义(RR=0.80,95%CI:0.67~0.95,P=0.01)。亚组分析显示,应用替格瑞洛与氯吡格雷短期治疗(数天),肺炎的发生风险相似(P=0.26);治疗时间≥12个月时,替格瑞洛组患者肺炎发生风险较低(RR=0.80,95%CI:0.67~0.96,P=0.02);与阿司匹林联用时,替格瑞洛组患者肺炎发生风险仍较氯吡格雷低(RR=0.74,95%CI:0.56~0.98,P=0.03)。结论与氯吡格雷比较,应用替格瑞洛治疗的患者肺炎发生风险较低。

Comparison of the risk for pneumonia in antiplatelet therapy with clopidogrel and ticagrelor: a meta-analysisCSCD

Objective To compare the risk for pneumonia in antiplatelet therapy with clopidogrel and ticagrelor. Methods The relevant databases including PubMed, Embase, Cochrane Library, CBM, CNKI, and Wanfang Med (up to March 1, 2022) were searched. The randomized controlled trials (RCTs) of clopidogrel and ticagrelor (trial group or control group to each other) in the treatment of coronary atheroscle-rotic heart disease were collected. The Cochrane collaboration risk of bias assessment tool was used to evaluate the methodological quality of the RCTs. RevMan 5.4 software was used for meta-analysis to compare the risk of pneumonia in patients between 2 groups. The effect sizes were the risk ratio (RR) and its 95% confidence interval (CI). Results A total of 5 RCTs were enrolled in the analysis. The methodological quality evaluation results showed that 2 RCTs were with low risk of bias and the others were high. In the 5 RCTs, 36 401 patients were involved, of which 18 724 received the therapy for acute coronary syndrome, 13 842 for peripheral artery disease, 3 799 for myocardial infarct, and 36 for coma survivor with cardiac arrest. The meta-analysis results showed that the incidence of pneumonia were 1.5%(271/18 174) and 1.2%(217/18 227) in patients receiving clopidogrel and ticagrelor, respectively; the risk of pneumonia in ticagrelor-treated patients was relatively lower, and the difference was statistically significant (RR=0.80, 95%CI: 0.67-0.95, P=0.01). Subgroup analysis showed that the risk for pneumonia was similar in patients between the 2 groups when they received short-term (several days) medication (P=0.26), while the risk was relatively lower in ticagrelor-treated patients compared with that in clopidogrel-treated patients when the therapeutical time was more than 12 months (RR=0.80, 95%CI: 0.67-0.96, P=0.02). And also, in the combination therapy with aspirin, the risk of pneumonia was lower in ticagrelor-treated patients than that in clopidogrel-treated patients (RR=0.74, 95%CI: 0.56-0.98, P=0.03). Conclusion Compared with clopidogrel, the risk for pneumonia was relatively lower in ticagrelor treatment than that in clopidogrel treatment. © 2023 The Author(s).