摘要
目的对活血化瘀中药治疗氯吡格雷抵抗的有效性及安全性进行系统评价。方法检索中国知网(CNKI)、万方数据库(Wanfang)、维普中文期刊(VIP)、中国生物医学文献库(SinoMed)、Embase、PubMed、Cochrane Library、Web of science等数据库自建库至2023年2月7日关于活血化瘀类中药治疗氯吡格雷抵抗患者的随机对照试验(RCT)。严格按照纳入和排除标准进行文献筛选,并进行数据提取,使用RevMan 5.4软件对纳入文献进行Meta分析。结果共纳入17篇文献,涉及患者1684例,试验组844例,对照组840例。Meta分析显示,试验组二磷酸腺苷(ADP)诱导的血小板聚集率显著低于对照组[SMD=-1.04,95%CI(-1.32,-0.76),P<0.00001];试验组在改善ADP诱导血小板聚集抑制率[SMD=3.99,95%CI(1.33,6.65),P=0.003]、血小板抑制率[SMD=0.91,95%CI(0.44,1.37),P=0.0001]、残余血小板活性单位(PRU)[MD=-17.66,95%CI(-28.55,-6.76),P=0.001]、残余血小板反应指数(PRI)[MD=-5.9,95%CI(-10.11,-1.70),P=0.006]以及残余血小板纤维蛋白凝块强度(ADPMA)[MD=-4.25,95%CI(-6.02,-2.84),P<0.00001]疗效均显著优于对照组;同时,试验组患者的再住院率[RR=0.54,95%CI(0.34,0.86),P=0.009]及缺血事件发生率显著低于对照组[RR=0.45,95%CI(0.26,0.78),P=0.004],而不增加出血风险[RR=0.64,95%CI(0.37,1.10),P=0.10],且2组普通不良反应差异无统计学意义[RR=0.69,95%CI(0.31,1.57),P=0.38]。结论活血化瘀中药防治氯吡格雷抵抗有确切的临床疗效,且安全性较好。但纳入RCT的低质量使得结论可信度下降,亟需更多高质量的RCT验证。
Objective To systematically evaluate the efficacy and safety of Chinese medicine for promoting blood and removing stasis in the treatment of clopidogrel resistance.Methods A comprehensive search of 8 Chinese and English databases,including CNKI,Wanfang,VIP,SinoMed,Embase,PubMed,Cochrane Library,and Web of science,from the establishment of the database to February 7,2023,was used to identify the randomized controlled trial of Chinese medicine for activating blood circulation and removing blood stasis in the treatment of patients with clopidogrel resistance.The literature was screened strictly according to the inclusion and exclusion criteria,and data extraction were performed.Meta-analysis and systematic evaluation of the included study were conducted using RevMan5.4 software.Results A total of 17 articles involving 1684 patients(844 patients in the trial group and840 patients in the control group)were included in this study.Meta-analysis showed that the platelet aggregation rate induced by adenosine diphosphate(ADP)in the trial group was significantly lower than that in the control group[SMD=-1.04,95%CI(-1.32,-0.76),P<0.00001].The intervention group was significantly better than the control group in terms of improving the ADP-induced aggregation inhibiting rate[SMD=3.99,95%CI(1.33,6.65),P=0.003],platelet inhibition rate[SMD=0.91,95%CI(0.44,1.37),P=0.0001],residual platelet reactivity unit(PRU)[MD=-17.66,95%CI(-28.55,-6.76),P=0.001],residual platelet reaction index(PRI)[MD=-5.9,95%CI(-10.11,-1.70),P=0.006],and residual platelet-fibrin clot strength(ADP-induced maximum amplitude,ADPMA)[MD=-4.25,95%CI(-6.02,-2.84),P<0.00001].Compared with the control group,the intervention group significantly reduced the rehospitalization rate of patients[RR=0.54,95%CI(0.34,0.86),P=0.009]and the incidence of ischemic events[RR=0.45,95%CI(0.26,0.78),P=0.004],but did not increase the risk of bleeding[RR=0.64,95%CI(0.37,1.10),P=0.10].The difference of the occurrence of adverse reactions in the two groups was not statistically significa
作者
田晶
徐柏榕
邢作英
邱伯雍
徐亚洲
郑佳
朱明军
王永霞
TIAN Jing;XU Bairong;XING Zuoying;QIU Boyong;XU Yazhou;ZHENG Jia;ZHU Mingjun;WANG Yongxia(Heart Center of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000 Henan,China)
出处
《中药新药与临床药理》
CAS
CSCD
北大核心
2023年第8期1141-1150,共10页
Traditional Chinese Drug Research and Clinical Pharmacology
基金
国家自然科学基金面上项目(82074229)
国家中医药管理局中医药循证能力建设项目(2019XZZX-XXG003)
河南省科技创新团队项目(C20130050)
河南省高校科技创新团队项目(131RTSTHN012)。
关键词
中药
活血化瘀
氯吡格雷抵抗
有效性
安全性
META分析
Chinese medicine
promoting blood and removing stasis
clopidogrel resistance
efficacy
safety
Meta-analysis
