PON1基因Q192R多态与氯吡格雷临床疗效及安全关联性的Meta分析（英文）

发布时间：2018-03-27 12:58

本文选题：氯吡格雷　切入点：芳基二烷基磷酸酶　出处：《中国新药与临床杂志》2015年09期

【摘要】：目的系统性评价PON1基因Q192R多态与氯吡格雷临床疗效及安全的关联性,以期为其临床研究及应用提供有效证据。方法计算机检索Embase、Medline、Pub Med、Web of Science、CNKI、万方、VIP、CBM数据库查找研究PON1基因Q192R多态与氯吡格雷临床疗效及安全相关性的临床研究,文献检索时限均从建库至2014年10月24日。对符合条件的研究,由两位研究者按照纳入和排除标准,独立筛选文献、提取资料、评价质量,并交叉核对后,采用Stata12.0软件对氯吡格雷抵抗、出血、主要不良心血管事件(MACE)、血小板反应活性及其抑制率进行Meta分析。结果共纳入32篇文献,包含34个研究(n=26 831)。Meta分析结果显示,PON1基因Q192R多态与服用氯吡格患者发生氯吡格雷抵抗和出血无关,氯吡格雷抵抗:192QR+192RR vs.192QQ[OR=0.92,95%CI(0.58~1.48),P=0.735],192RR vs.192QR+192QQ[OR=1.06,95%CI(0.87~1.29),P=0.583],192RR vs.192QQ[OR=1.00,95%CI(0.56~1.79),P=0.995];出血:192QR+192RR vs.192QQ[OR=0.92,95%CI(0.74~1.16),P=0.489],192RR vs.192QR+192QQ[OR=0.75,95%CI(0.56~1.02),P=0.066],192RR vs.192QQ[OR=0.70,95%CI(0.48~1.02),P=0.066)];同样,PON1基因Q192R多态对服用氯吡格雷患者发生MACE无影响,MACE:192QR+192RR vs.192QQ[OR=0.85,95%CI(0.71~1.03),P=0.092],192RR vs.192 QR+192QQ[OR=0.90,95%CI(0.71~1.15),P=0.406],192RR vs.192QQ[OR=0.89,95%CI(0.63~1.27),P=0.521]。此外,PON1基因Q192R多态可能增加服用氯吡格雷患者治疗中血小板活性反应及降低其抑制率,血小板反应活性抑制率:192QR+192RR vs.192QQ[WMD=-1.04,95%CI(-4.83~2.75),P=0.591],192RR vs.192QR+192QQ[WMD=-3.67,95%CI(-7.84~0.50),P=0.084],192RR vs.192QQ[WMD=-4.99,95%CI(-9.96~0.02),P=0.049];血小板反应活性:192QR+192RR vs.192QQ[WMD=0.85,95%CI(-0.47~2.16),P=0.209],192RR vs.192QR+192QQ[WMD=0.57,95%CI(-2.28~3.43),P=0.694],192RR vs.192QQ[WMD=2.12,95%CI(-1.42~5.65),P=0.240]。结论 PON1基因多态尽管可能影响血小板反应活性,但对服用氯吡格雷患者发生氯吡格雷抵抗、出血和MACE无影响,总之,PON1基因多态对服用氯吡格雷患者的疗效及安全性无影响。
[Abstract]:Objective to evaluate systematically the association between Q1921 R polymorphism of PON1 gene and clopidogrel clinical efficacy and safety. To provide effective evidence for its clinical study and application. Methods the clinical study on the relationship between PON1 Q19R polymorphism and clopidogrel clinical efficacy and safety was studied by computer searching the Embase Medline of Pub Medboard of Web of ScienceCKI, Wanfang Vipric CBM database, and the clinical efficacy and safety of clopidogrel. The time limit for document retrieval was from the establishment of the database to October 24, 2014. According to the criteria of inclusion and exclusion, the two researchers independently screened documents, extracted data, evaluated the quality and cross-checked the eligible studies. Stata12.0 software was used to analyze clopidogrel resistance, bleeding, major adverse cardiovascular events, platelet reaction activity and inhibition rate by Meta. Results of 831).Meta analysis of 34 studies revealed that the Q1921 R polymorphism of the PON1 gene was not associated with clopidogrel resistance and bleeding in clopidogrel patients. Clopidogrel resists the 1922 QR 192RR vs.192QQ [OR0.9295CI0.581.48Pnr 0.735] vs.192QR 192QQ [OR1.069595CI0.871.29Con 0.583] 1922 vs.192QQ [OR1.0095CI0.561.79P0.995]; 1922 QR 192RR vs.192QQ [OR0.9295CII 0.16Pn0.489] 1922 vs.192QR 192QQ. Platelet active reaction and its inhibition rate were reduced during the treatment. The inhibition rate of platelet response activity was 1922 QR 192RR vs.192QQ [WMD-1.0495 CI-4.832.75 P0.591] vs.192QR 192QQ [WMD-3.6795 CI-7.84 0.50 P0. 084] vs.192QQ [WMD-4.995 CI-9.995 CI-9.96 0.02]; Platelet-reactive activity of 1922 QR 192RR vs.192QQ [WMD0.85CI-0.472.16P0.209] RR 1922 vs.192QR 192QQ [WMD-0.5795CI-2.283.95CI-2.283.43C / P0.694]; Haemorrhage and MACE had no effect, but PON1 gene polymorphism had no effect on efficacy and safety of clopidogrel patients.
【作者单位】：昆明理工大学附属医院;云南省第一人民医院药剂科;昆明理工大学医学院;云南省第一人民医院护理部;
【分类号】：R969

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