塞来昔布心血管安全性的系统评价与荟萃分析

发布时间：2019-05-09 02:00

【摘要】：目的:对长期使用塞来昔布的心血管安全性进行系统综述和荟萃分析。方法:计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、ClinicalTrials.gov、中国生物医学文献数据库(CBM)、万方数据库,检索时限从建库至2017年4月,同时手工检索纳入文献的参考文献,美国FDA网站有关塞来昔布药物试验的数据,2015年ESC年会会议文献,纳入有关塞来昔布长期使用的心血管安全性的随机对照试验。由两名研究者按纳入与排除标准独立选择文献、提取资料和评价质量并交叉核对后,采用Review Manager 5.3软件进行效应量的合并。结果:最终纳入7项研究,共58744例患者。Meta分析结果显示,塞来昔布组复合心血管事件发生率、心肌梗死发生率、心血管死亡发生率以及卒中的发生率与安慰剂组相比差别无统计学意义(P均0.05)。与非选择性NSAIDs(nonselective nonsteroidal anti-inflammatory drugs,nsNSAIDs)组比较,塞来昔布组复合心血管事件发生率、心肌梗死发生率、心血管死亡发生率、卒中发生率均低于nsNSAIDs组,但差别均无统计学意义(P均0.05)。进一步按是否使用低剂量阿司匹林进行复合心血管事件的分层比较,在使用低剂量阿司匹林人群中,塞来昔布组复合心血管事件的发生率高于安慰剂组,但差别无统计学意义(2.73%比1.85%,RR=1.36,95CI 0.94~1.97,P=0.11);未使用低剂量阿司匹林人群中塞来昔布组复合心血管事件的发生率显著高于安慰剂组(3.83%比2.23%,RR=1.58,95CI 1.13~2.21,P=0.008)。结论:塞来昔布长期使用存在一定程度的潜在心血管风险,其心血管风险与非选择性NSAIDs相当。
[Abstract]:Objective: to review and meta-analyze the cardiovascular safety of celecoxib for a long time. Methods: the PubMed,Embase,Web of Science,Cochrane Library and (CBM), Wanfang Database of Chinese Biomedical Literature Database were searched by computer, and the time limit of searching was from April 2017 to April 2017. At the same time, the references included in the literature were searched by hand. FDA data on celecoxib drug trials, the 2015 ESC conference literature, were included in randomized controlled trials on the cardiovascular safety of long-term use of celecoxib. Two researchers independently selected the literature according to the inclusion and exclusion criteria, extracted the data and evaluated the quality, and cross-checked the results. Then, the results were combined with Review Manager 5.3 software. Results: a total of 58744 patients were enrolled in 7 studies. Meta-analysis showed that celecoxib combined with cardiovascular events and myocardial infarction occurred in the celecoxib group. There was no significant difference in the incidence of cardiovascular death and stroke between the placebo group and the placebo group (P 0.05). Compared with the non-selective NSAIDs (nonselective nonsteroidal anti-inflammatory drugs,nsNSAIDs group, the incidence of combined cardiovascular events, myocardial infarction, cardiovascular death and stroke in the celecoxib group were lower than those in the nsNSAIDs group. But there was no significant difference between the two groups (P 0.05). A further stratified comparison of combined cardiovascular events by low-dose aspirin showed that the celecoxib group had a higher incidence of combined cardiovascular events than the placebo group in the low-dose aspirin group. But there was no significant difference (2.73% vs 1.85%, RR = 1.36, 95 CI 0.94 / 1.97, P = 0.11). The incidence of combined cardiovascular events in the celecoxib group was significantly higher than that in the placebo group (3.83% vs 2.23%, RR 1.58, 95CI 1.13 / 2.21, P = 0.008). Conclusion: there is a potential cardiovascular risk in long-term use of celecoxib, and its cardiovascular risk is similar to that of non-selective NSAIDs.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54

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