氯吡格雷与质子泵抑制剂联用治疗冠心病安全性的系统评价

发布时间：2018-03-13 23:47

本文选题：氯吡格雷　切入点：质子泵抑制剂　出处：《中国循证医学杂志》2011年03期 　论文类型：期刊论文

【摘要】：目的对冠心病患者单用氯吡格雷和联合使用氯吡格雷质子泵抑制剂(PPI)的安全性(心血管事件、死亡或胃肠道出血等)进行系统评价。方法计算机检索Cochrane图书馆、PubMed、EMbase、SSCI、VIP、CNKI及CBM数据库,检索时间均从建库至2010年9月,并追踪已获文献的参考文献,由2名研究者独立进行质量评价及数据提取,而后采用RevMan 5.0软件进行Meta分析。结果共纳入29篇文献,合计142 401例患者。Meta分析结果显示:氯吡格雷与质子泵抑制剂联用有增加心血管事件的风险[RR=1.27,95%CI(1.09,1.47)],同时存在增加心肌梗死[RR=1.45,95%C(I1.20,1.76)]、总病死率[RR=1.23,95%C(I1.06,1.43)]、再次血栓[RR=1.37,95%C(I1.01,1.86)]的风险。此外,两者联用与胃肠道出血风险的关系还不明确[RR=0.84,95%CI(0.47,1.50)]。结论氯吡格雷与质子泵抑制剂联用会增加心血管事件、病死率、心肌梗死及再次血栓的风险,但在降低胃肠道出血的作用方面尚需更多临床研究证实。
[Abstract]:Objective to evaluate the safety of clopidogrel alone and clopidogrel proton pump inhibitor (PPI) (cardiovascular events, death or gastrointestinal bleeding) in patients with coronary heart disease. The retrieval time was from the construction of the database to September 2010, and the reference documents were followed up. The quality evaluation and data extraction were carried out by two researchers independently, and then Meta analysis was carried out with RevMan 5.0 software. The results were included in 29 articles. A meta-analysis of 142,401 patients showed that clopidogrel combined with proton pump inhibitors had an increased risk of cardiovascular events [RRN 1.2795 CI1. 09 / 1.47] and increased myocardial infarction [RR1. 45% 95 Con I 1. 20 + 1. 76], total case fatality rate [RR1. 2395 Con I 1.06 / 1.43], and a risk of re-thrombosis [RRN 1. 379 95 CI 1.011 1. 86]. The relationship between the combination of the two drugs and the risk of gastrointestinal bleeding is unclear [RRX 0.8495 CI0.471.50]. Conclusion Clopidogrel combined with proton pump inhibitor can increase cardiovascular events, mortality, myocardial infarction and the risk of re-thrombosis. But more clinical research is needed to confirm the effect of reducing gastrointestinal bleeding.
【作者单位】：南京医科大学附属南京第一医院临床药理实验室;中国药科大学江宁校区药学院;南京医科大学附属南京第一医院心内科;
【基金】：国家自然科学基金资助项目(编号:30901830) 南京市科技发展计划项目(编号:201001098) 南京医科大学重点项目课题(编号:09NJMUZ36)
【分类号】：R541.4

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