| 普拉格雷和氯吡格雷对冠心病患者疗效和安全性的Meta分析 |
| 投稿时间：2014-06-26 修订日期：2014-08-19 点此下载全文 |
| 引用本文：王欣,夏豪,童随阳,李磊.普拉格雷和氯吡格雷对冠心病患者疗效和安全性的Meta分析[J].医学研究杂志,2015,44(2):49-54 |
| DOI：
10.3969/j.issn.1673-548X.2015.02.014 |
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| 基金项目:国家自然科学基金资助项目(81270184) |
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| 中文摘要:目的 比较普拉格雷(prasugrel)与氯吡格雷(clopidogrel)治疗冠心病的疗效和安全性。方法 计算机检索PubMed、Medline、Cochrane Central Register of Controlled Trials、CNKI全文数据库, 收集2006年1月~2014年6月公开发表的有关普拉格雷和氯吡格雷疗效比较的随机对照试验(RCT), 手检已获文献的参考文献、会议摘要及相关网站。对文献质量进行严格评价后, 对符合要求的RCTs进行资料提取并采用RevMan5.0软件进行Meta分析。结果 共纳入5项RCTs, Meta分析显示, 普拉格雷组与氯吡格雷组之间全因病死率(OR=0.94, 95% CI:0.86~1.16, P=0.32)、心肌梗死(MI)发生率(OR=0.82, 95% CI:0.68~1.00, P=0.05)、脑卒中发生率(OR=0.96, 95% CI:0.75~1.22, P=0.72)均无统计学意义;普拉格雷组主要不良心脏事件(MACE)发生率(OR=0.45, 95% CI:0.34~0.59, P=0.000)、支架内血栓发生率(OR=0.79, 95% CI:0.63~0.98, P=0.04)均低于氯吡格雷组, 但大出血发生率(OR=1.26, 95% CI:1.03~1.55, P=0.02)高于氯吡格雷组。结论 在冠心病双重抗血小板治疗中, 第2代P2Y12二磷酸腺苷受体拮抗剂普拉格雷能更显著降低MACE发生率、支架内血栓发生率, 在全因病死率、MI发生率、脑卒中发生率与氯吡格雷相似, 但能增加大出血的风险。 |
| 中文关键词:普拉格雷 氯吡格雷 冠心病 |
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| Meta Analysis of the Efficacy and Safety of Prasugrel and Clopidogrel in Patients with Coronary Heart Disease |
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| Abstract:Objective To compare the efficacy and safety of prasugrel and clopidogrel in patients with coroanry heart disease(CHD). Methods The databases of PubMed, Medline, CENTRAL and CNKI were retrieved with computers for collecting randomized controlled trials(RCT)about the comparison in the efficacy and safety of prasugrel and clopidogrel published from Jan 2006 to Jun 2014. At the same time, the reference materials of included literature were retrieved manually. After rigorous evaluation on literature quality, the eligible data of RCT was extracted and given a Meta-analysis by applying RevMan5.0 software. Results There were totally 5 RCTs included, and the results of Meta-analysis showed that between prasugrel and clopidogrel group the all cause death events(OR=0.94, 95% CI:0.86-1.16, P=0.32), and the incidence of MI events(OR=0.82, 95% CI:0.68-1.00, P=0.05), the incidence of stroke events(OR=0.96, 95% CI:0.75-1.22, P=0.72) all had no significant difference. The incidence of major adverse cardiac events(MACE) (OR=0.45, 95%CI:0.34-0.59, P=0.000), stent thrombosis(OR=0.79, 95% CI:0.63-0.98, P=0.04) was lower in prasugrel group than those in clopidogrel group, while the incidence of major bleeding(OR=1.26, 95% CI:1.03-1.55, P=0.02) was higher than clopidogrel. Conclusion In the treatment of CHD with dual antiplatelet, prasugrel can significantly reduce the incidence of MACE, stent thrombosis, but is similar to clopidogrel in the rate of all cause death, MI, stroke, while prasugrel can increase the risk of bleeding. |
| keywords:Prasugrel Clopidogrel Coronary heart disease |
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