| 尹毓瑶,张新鑫,潘一龙,等.比较替格瑞洛和氯吡格雷治疗急性冠脉综合征合并糖尿病不同随访时间疗效和安全性的 Meta分析[J].安徽医药,2021,25(10):1909-1915. |
| 比较替格瑞洛和氯吡格雷治疗急性冠脉综合征合并糖尿病不同随访时间疗效和安全性的 Meta分析 |
| A meta-analysis of the effect and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome and diabetes mellitus with different lengths of follow-up |
| |
| DOI：10.3969/j.issn.1009-6469.2021.10.001 |
| 中文关键词: 急性冠状动脉综合征 糖尿病 替格瑞洛 氯吡格雷 Meta分析观察， |
| 英文关键词: Acute coronary syndromes Diabetes mellitus Ticagrelor Clopidogrel Meta-analysis |
| 基金项目:国家科技支撑计划( 2014BAL11B04)“十二五” |
|
| 摘要点击次数: 1424 |
| 全文下载次数: 573 |
| 中文摘要: |
| 目的使用 Meta方法评价替格瑞洛和氯吡格雷在急性冠脉综合征合并糖尿病病人不同随访时间的疗效和安全性。方法计算机检索 PubMed、Embase、中国知网数据库、维普数据库，检索范围为从建库到 2020年 4月 30日。收集替格瑞洛(观察组)和氯吡格雷(对照组)分别在急性冠脉综合征合并糖尿病病人中使用的随机对照试验(RCT)；筛选文献、提取数据资料并评价文献质量后，使用 Revman 5.1和 stata 15软件进行荟萃分析。结果本研究共纳入 21篇文献，病例总数 3 155例。与对照组相比，观察组有较低的主要心血管不良事件发生率［随访时间 <6个月: RR=0.41，95%CI:0.30~0.57；随访时间 ≥6个月: RR=0.51，95%CI: 0.37~0.71］和较高的左心室射血分数(随访时间 <6个月: MD=1.50，95%CI:0.91~2.08；随访时间 ≥6个月: MD=3.23，95%CI:2.23~4.23］，均差异有统计学意义且与随访时间的长短无关。当随访时间短(<6个月)时，观察组与对照组的全因死亡率差异无统计学意义(P=0.74)观察组的左心室舒张末期内径值 LVEDD高于对照组(RR=3.13，95%CI:1.38~4.88，P=0.000 4)。当随访时间较长(≥6个月)时，组跟对照组相比有更低的全因死亡率( RR=0.55，95%CI:0.34~0.91)和( MD=?4.19，95%CI:?5.36~?3.02)，均差异有统计学意义。与对照组相比，观察组的呼吸困难发生率(%)较高(随访时间 <6个月: RR=7.42，95%CI:1.71~32.10；随访时间 ≥ 6个月: RR=2.45，95%CI:1.44~4.17)而出血事件发生率二者差异无统计学意义，与随访时间的长短无关。当随访时间 ≥12个月时，观察组和对照组的出血事件发生率可能存在较大的差别( RR=0.71，95%CI:0.50~1.02，P=0.06)。结论在急性冠脉综合征合并糖尿病病人中，长随访时间下替格瑞洛相比于氯吡格雷有较好的疗效和较差的安全性。 |
| 英文摘要: |
| Objective To evaluate the efficacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome(ACS) and diabetes mellitus (DM) with different lengths of follow-up using meta-analysis.Methods PubMed, EMbase, CNKI and VIPdatabase were retrieved for the literature on the randomized controlled trial (RCTs) of ticagrelor and clopidogrel used for patients withacute coronary syndrome combined with diabetes. The retrieval time range was from the building time to April 30, 2020. After literaturescreening, data extraction and literature quality assessment, Revman 5.1 and Stata 15 software were used for meta-analysis.Results This study included 21 papers, with a total of 3 155 cases. Compared with the control group, the observation group had a lower incidence of major adverse cardiac events (%) [length of follow-up<6 m: RR=0.41, 95%CI=0.30-0.57; length of follow-up≥6 m:RR=0.51, 95%CI= 0.37-0.71] and a higher left ventricular ejection fraction-LVEF(%) [length of follow-up<6 m:MD=1.50, 95%CI=0.91-2.08; length of follow-up≥6m:MD=3.23, 95%CI=2.23-4.23]. The differences were all statistically significant and the results had no correlation with the follow-up time. When the follow-up time was short (< 6 m), there was no significant difference in all-cause mortality (%) between the observation group and the control group (P=0.74) and the left ventricular end diastolic dimension LVEDD (mm) of the observation group was higher than the control group [RR=3.13, 95%CI=1.38-4.88, P=0.000 4]. When the follow-up time was longer (≥6 m), the observation group had lower all-cause mortality [RR=0.55, 95%CI=0.34-0.91] and LVEDD [MD=?4.19, 95%CI=?5.36-?3.02]than the control group. The differences were statistically significant. Compared with the control group, the observation group had a higher incidence of dyspnea(%) [length of follow-up<6 m:RR=7.42, 95%CI=1.71-32.10; length of follow-up≥6 m:RR=2.45, 95%CI= 1.444.17], but there was no statistical difference in the incidence of bleeding events(%), which was independent of the length of follow-up. When the length of follow-up was ≥12 m, there might be a significant difference in the incidence of bleeding events between the obser vation group and the control group [ RR=0.71, 95%CI=0.50~1.02, P=0.06].Conclusion Ticagrelor has better efficacy and less safety than clopidogrel in ACS patients complicated with diabetes mellius with a long-term follow-up. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
