替格瑞洛与氯吡格雷治疗急性冠脉综合征疗效比较的Meta分析

摘要

Objective To compare the curative effect and safety of ticagrelor and clopidogrel in treatment of acute coronary syndrome (ACS). Methods The databases of PubMed, CENTRAL and CNKI were retrieved with computer for collecting the RCT about comparison in curative effect and safety of ticagrelor and clopidogrel in treatment of ACS supplemented manually for searching reference from Jan. 2007 to Apr. 2014. After rigorous reviewing on quality, the data was extracted from eligible RCT and given a Meta-analysis by using RevMen5.1 software. Results There were totally 6 RCT included. The results of Meta-analysis showed that there was no statistical difference between ticagrelor and clopidogrel in the incidence of MACE (OR=0.67, 95%CI:0.40-1.11, P=0.12), myocardial infarction (OR=0.92, 95%CI: 0.81-1.04, P=0.17), stoke (OR=1.15, 95%CI: 0.89- 1.49, P=0.28) and bleeding (OR=1.05, 95%CI:0.96-1.15, P=0.31), but there was statistical difference in the incidence of dyspnea (OR=1.87, 95%CI:1.70-2.06, P<0.00001). Conclusion In ACS treatment, the incidence of dyspnea is higher when administrating ticagrelor, but incidence of MACE, myocardial infarction, stoke and bleeding were similar when administrating ticagrelor or clopidogrel. Clopidogrel may be substituted by ticagrelor, especially in the patients with clopidogrel intolerance or resistance.%目的：比较替格瑞洛与氯吡格雷治疗急性冠脉综合征（ACS）的疗效与安全性。方法计算机检索PubMed、Cochrane Central Register of Controlled Trials、CNKI全文数据库，收集2007年1月至2014年4月公开发表的有关替格瑞洛与氯吡格雷治疗急性冠脉综合征疗效和安全性比较的随机对照试验（RCTs），同时辅以手检纳入文献的参考文献。对文献质量进行严格评价后，符合要求的RCTs进行资料提取，采用RevMen5.1软件进行Meta分析。结果共纳入6项RCTs，Meta分析显示：替格瑞洛组与氯吡格雷组之间的主要心脏不良事件（MACE）发生率（OR=0.67，95%CI：0.40～1.11，P=0.12）、心肌梗死发生率（OR=0.92，95%CI：0.81～1.04，P=0.17）、卒中发生率（OR=1.15，95%CI：0.89～1.49， P=0.28）、出血发生率（OR=1.05，95%CI：0.96～1.15，P=0.31）均无统计学差异，但呼吸困难发生率（OR=1.87，95%CI：1.70～2.06，P＜0.00001）有统计学差异。结论在ACS的治疗中，替格瑞洛虽然在呼吸困难发生率上显著高于氯吡格雷，但在MACE、心肌梗死、卒中、出血发生率中与氯吡格雷相似。替格瑞洛具有替代氯吡格雷的潜力，特别是对于不能耐受氯吡格雷和有氯吡格雷抵抗的患者。