摘要
目的系统评价冠心病合并慢性肾病经皮冠状动脉介入术(PCI)后患者使用替格瑞洛的有效性和安全性。方法计算机检索中国知网、万方、维普、PubMed、Web of Science、Embase、Cochrane Library数据库。根据Cochrane系统评价手册和纽卡斯尔-渥太华量表(NOS)对纳入研究的质量进行评价。采用Stata 15.0软件进行Meta分析。结果共纳入了10项研究,涉及4项随机对照试验和6项队列研究,合计8110例冠心病合并慢性肾病PCI术后患者,试验组3356例,对照组4754例。Meta分析结果显示:在有效性方面,两组患者不良心脑血管事件(MACCE)(OR=0.78,95%CI:0.68~0.89,P<0.001)、心肌梗死发生率(OR=0.76,95%CI:0.62~0.93,P<0.001)比较,差异均有统计学意义;两组患者全因死亡(OR=0.81,95%CI:0.59~1.10,P=0.179)、心源性死亡(OR=0.76,95%CI:0.54~1.05,P=0.542)、卒中(OR=0.87,95%CI:0.65~1.17,P=0.354)、重复血运重建发生率(OR=0.73,95%CI:0.51~1.04,P=0.077)比较,差异无统计学意义。在安全性方面,两组患者出血发生率(OR=1.12,95%CI:0.85~1.46,P=0.432)比较,差异无统计学意义。结论应用替格瑞洛治疗冠心病合并慢性肾病PCI术后患者,全因死亡、心源性死亡、卒中、重复血运重建发生率与对照组相比疗效相当,但是替格瑞洛可有效降低MACCE、心肌梗死的发生率,且不增加出血风险。
Objective To systematically evaluate the efficacy and safety of the use of ticagrelor in patients with coronary artery disease combined with chronic kidney disease after percutaneous coronary intervention(PCI).Methods Computerized searches were performed on China National Knowledge Infrastructure(CNKI),Wan Fang Data Knowledge Service Platform(WanFang),Vip Chinese Science and Technology Journal Database(VIP),PubMed,Web of Science,Embase,and Cochrane Library databases.The quality of the included studies was evaluated according to the Cochrane Handbook of Systematic Evaluation and the Newcastle-Ottawa Scale(NOS)scale.Meta-analysis was performed using Stata 15.0.Results A total of 10 studies,involving 4 randomized controlled trials(RCTs)and 6 cohort studies,were included,enrolling a total of 8110 post-PCI patients with coronary artery disease combined with chronic kidney disease.There were 3356 patients in the trial group and 4754 patients in the control group.Metaanalysis results showed that,in terms of effectiveness,the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)(OR=0.78,95%CI:0.68-0.89,P<0.001),and that of myocardial infarction(OR=0.76,95%CI:0.62-0.93,P<0.001)in the patients were statistically different between the two groups.Comparing the incidence of all-cause death(OR=0.81,95%CI:0.59-1.10,P=0.179),cardiac death(OR=0.76,95%CI:0.54-1.05,P=0.542),stroke(OR=0.87,95%CI:0.65-1.17,P=0.354),and repetitive revascularization(OR=0.73,95%CI:0.51-1.04,P=0.077)between the two groups,the difference was not statistically significant.In terms of safety,there was no statistically significant difference in the incidence of bleeding(OR=1.12,95%CI:0.85-1.46,P=0.432)between the two groups.Conclusion The treatment of post-PCI patients with coronary artery disease combined with chronic kidney disease by using ticagrelor is effective in reducing the incidence of MACCE and myocardial infarction without increasing the risk of bleeding.Meanwhile,the incidence of all-cause mortality,cardiac death,stroke,and
作者
尹秀平
徐杨
王义国
高艳
刘新新
侯新
张启明
Yin Xiu-ping;Xu Yang;Wang Yi-guo;Gao Yan;Liu Xin-xin;Hou Xin;Zhang Qi-ming(Experimental Research Center,China Academy of Chinese Medical Sciences,Beijing 100700,China;Chinese Medicine Outpatient Clinic,China Academy of Chinese Medical Sciences,Beijing 100700,China;Center for Evidence-Based Medicine,Beijing University of Chinese Medicine,Beijing 100105,China;Department of Pharmacy,Guang’anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)
出处
《中国药物应用与监测》
CAS
2024年第2期130-135,共6页
Chinese Journal of Drug Application and Monitoring
基金
中国中医科学院医学实验中心揭榜挂帅项目(JBGS2021009)
中国中医科学院科技创新工程课题(CI2021A05407)
国家科学技术部重点研发计划项目(2019YFC1711700)
首都卫生发展科研专项(首发2024-4-4381)。
关键词
慢性肾病
冠心病
替格瑞洛
经皮冠状动脉介入术
系统评价
Chronic kidney disease
Coronary artery disease
Ticagrelor
Percutaneous coronary intervention
Systematic evaluation
