阿司匹林对糖尿病患者心脑血管事件一级预防的荟萃分析

目的 系统评价阿司匹林对糖尿病患者心脑血管事件一级预防的疗效及安全性.方法 电子检索数据席MEDLINE、EMBASE、Cochrane图书馆、维普数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库等,文献检索时间为建库至2009年7月,检索关键词包括阿司匹林、糖尿病、一级预防、心血管事件、心肌梗死、卒中,文献语种不限.检索纳入文献的参考文献.纳入阿司匹林降低糖尿病患者心脑血管并发症的所有前瞻性随机对照试验,评价纳入研究的方法学质量,并提取符合纳入标准的数据,采用RevMan 5.0软件进行荟专笔分析.结果 共纳入4项随机对照试验中的5883例糖尿病患者.荟萃分析结果显示:阿司匹林可使糖尿病患者卒中事件的发生率降低近30%(RR=0.71,95%CI为0.55～0.93,P=0.01),阿司匹林组与对照组主要心血管事件(RR=0.90,95%CI为0.77～1.04,P=0.15)及心肌梗死事件(RR=1.02,95%CI为0.78～1.32,P=0.90)无显著差异.阿司匹林对不同性别糖尿病患者主要心血管事件的影响无显著差异.阿司匹林可使糖尿病患者主要出血事件的发生风险增加4倍(RR=4.03,95%CI为2.09～7.78,P<0.0001),阿司匹林组与对照组心源性死亡事件(RR=0.85,95%CI为0.32～2.24,P=0.74)及全因死亡事件(RR=0.87,95%CI为0.47～1.61,P=0.67)无显著差异.结论 阿司匹林能显著降低糖尿病患者卒中事件的发生风险,增加出血事件的发生风险.

Meta-analysis of aspirin in primary prevention of cardiovascular events in patients with diabetes

Objective To systemically review the efficacy of aspirin on the primary prevention of cardio-cerebrovascular events in diabetic patients. Methods Database search of MEDLINE, EMBASE, Cochrane Controlled Trials Register, VIP Database, CNKI, CBM disc (from the date of database establishment to July 2009) was carried out. The key words included diabetes, hyperglycemia, aspirin, acetylsalicylic acid hydrolase, non-steroidal anti-inflammatory drugs (NSAIDS), primary prevention, cardiovascular diseases, myocardial infarction, and stroke. No language restriction was applied. Additional studies were retrieved via references of the articles and directed conduct of authors to possess relevant data. Prospective randomized controlled trials without previous history of cardiovascular disease in diabetic patients were selected. Quality of all the studies was evaluated, and the data which met the inclusion criteria were extracted. Review Manager Software 5.0 was used for statistical analysis. Results Four trials with a total of 5883 participants were included. The meta-analysis showed that aspirin was associated with 30% reduction in stroke (RR =0.71,95% CI 0.55 to 0.93, P=0.01), but no significant effect on major cardiovascular events (RR = 0.90, 95% CI 0.77 to 1.04, P = 0.15) or myocardial infarctions (RR = 1.02, 95% CI 0.78 to 1.32, P = 0.90) was found, and no sex-specific difference was identified. Aspirin increased more than 4 odds of bleeding events compared with the control group (RR = 4.03, 95% CI 2.09 to 7.78, P < 0.0001). There was no significant difference between the aspirin group and the control group in cardiovascular mortality (RR = 0.85, 95% CI 0.32 to 2.24, P = 0.74) and major mortality (RR = 0.87, 95% CI 0.47 to 1.61, P = 0.67). Conclusions Findings from this meta-analysis suggest that low-dose aspirin therapy could significantly reduce the risk of stroke, although increasing the risk of bleeding in diabetic patients.