替格瑞洛对比氯吡格雷治疗急性冠状动脉综合征有效性与安全性的Meta分析

目的:系统评价替格瑞洛对比氯吡格雷治疗急性冠状动脉综合征(ACS)的有效性和安全性,旨在为临床用药提供循证参考。方法:计算机检索PubMed、Embase、Cochrane图书馆、中国生物医学文献光盘数据库、中国期刊全文数据库等,收集替格瑞洛(试验组)对比氯吡格雷(对照组)治疗ACS的随机对照试验(RCT)。筛选文献、提取资料并采用改良Jadad量表评价质量后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入26项RCT,合计8 560例患者。Meta分析结果显示,试验组患者主要不良心脏事件发生率RR=0.47,95%CI(0.38,0.57),P<0.000 01]、脑卒中发生率RR=0.24,95%CI(0.08,0.69),P=0.008]、血小板聚集率SMD=-3.16,95%CI(-4.16,-2.16),P<0.000 01]、C反应蛋白水平SMD=-1.02,95%CI(-1.76,-0.29),P=0.006]均显著低于对照组,尿酸水平SMD=0.64,95%CI(0.39,0.88),P<0.000 01]显著高于对照组;两组患者主要出血事件发生率RR=0.96,95%CI(0.66,1.40),P=0.85]、呼吸困难发生率RR=1.19,95%CI(0.78,1.80),P=0.42]比较,差异均无统计学意义。结论:替格瑞洛治疗ACS的疗效和安全性均优于氯吡格雷,但可引起尿酸升高。

Meta-analysis of Efficacy and Safety of Ticagrelor versus Clopidogrel in the Treatment of Acute Coronary Syndrome

OBJECTIVE:To systematically evaluate the efficacy and safety of ticagrelor versus clopidogrel in the treatment of acute coronary syndrome(ACS).METHODS:Retrieved from PubMed,Embase,Cochrane Library,CBM and CNKI,randomized controlled trials(RCTs)about ticagrelor(trial group)and clopidogrel(control group)in the treatment of ACS were included.After literature screening,data extraction and quality evaluation with modified Jadad scale,Meta-analysis was performed by using Rev Man 5.3 software.RESULTS:26 RCTs were included,involving 8 560 patients.Meta-analysis showed that the incidence of main adverse cardiac eventRR=0.47,95%CI(0.38,0.57),P<0.000 01]and strokeRR=0.24,95%CI(0.08,0.69),P=0.008],platelet aggregation rateSMD=-3.16,95%CI(-4.16,-2.16),P<0.000 01]and C-reactive protein levelSMD=-1.02,95%CI(-1.76,-0.29),P=0.006]in trial group were significantly lower than control group;uric acid levelSMD=0.64,95%CI(0.39,0.88),P<0.000 01]of trial group was significantly higher than control group.There was no statistical significance in the incidence of main bleeding eventRR=0.96,95%CI(0.66,1.40),P=0.85]or dyspneaRR=1.19,95%CI(0.78,1.80),P=0.42]between 2 groups.CONCLUSIONS:The efficacy and safety of ticagrelor is superior to those of clopidogrel in treatment of ACS,but ticagrelor can cause the elevation of uric acid.