替格瑞洛在冠心病合并慢性阻塞性肺病中应用的有效性和安全性meta分析

目的 分析在冠心病合并慢性阻塞性肺病（COPD）中应用替格瑞洛的安全性以及有效性。方法 计算机检索中国知网、维普、PubMed、OVID、web of science等国内外数据库，收集在冠心病合并COPD患者中应用替格瑞洛对比氯吡格雷的临床试验。本次试验的主要终点为冠心病合并COPD患者呼吸困难发生率、出血发生率以及心血管源性不良事件的发生率。结果 本次研究共纳入7篇文献，meta分析结果显示，对比氯吡格雷组，替格瑞洛组呼吸困难发生率显著升高（24.5% vs 13.8%，OR：2.04，95%CI：1.56 2.66，P<0.05）；但替格瑞洛组在心肌梗死率（6.8% vs 10.6%，OR：0.61，95%CI：0.43 0.87，P<0.05）、卒中发生率（1.1% vs 2.9%，OR：0.41，95%CI：0.20 0.84，P<0.05）、心源性死亡率（4.9% vs 8.8%，OR：0.53，95%CI：0.35 0.79，P<0.05）上均比氯吡格雷组具有显著优势。结论 替格瑞洛在冠心病合并COPD患者中呼吸困难的发生率较高，但心血管源性不良事件的发生率显著低于氯吡格雷组。

Efficacy and safety of ticagrelor in coronary artery disease and chronic obstructive pulmonary disease: a meta analysis

Objective To analyze the safety and efficacy of ticagrelor in patients with coronary artery disease and chronic obstructive pulmonary disease (COPD). Methods The clinical trials of ticagrelor versus clopidogrel in patients with coronary artery disease and COPD were searched in domestic and foreign databases which included CNKI, VIP, PubMed, OVID, web of science. The primary endpoints of this study were the incidence of dyspnea, bleeding and cardiovascular adverse events in patients with coronary artery disease and COPD. Results In this study, 7 articles were included. Meta analysis showed that the incidence of dyspnea was significantly increased in ticagrelor group compared with clopidogrel group(24.5% vs 13.8%, OR：2.04，95%CI：1.56 2.66, P<0.05). However, ticagrelor group had significant advantages over clopidogrel group in myocardial infarction rate (6.8% vs 10.6%, OR：0.61，95%CI：0.43 0.87, P<0.05), stroke incidence rate (1.1% vs 2.9%, OR：0.41，95%CI：0.20 0.84, P<0.05) and cardiogenic mortality (4.9% vs 8.8%, OR：0.53，95%CI：0.35 0.79, P<0.05). Conclusion Patients with coronary artery disease and COPD in ticagrelor group had a higher incidence of dyspnea, but the incidence of cardiovascular adverse events was significantly lower than that of clopidogrel group.