【作者】 吴丹；

【导师】 吴清华；

【作者基本信息】 南昌大学 ， 内科学（心血管内科）（专业学位）， 2020， 硕士

【摘要】 目的:探讨NSTE-ACS患者介入治疗前使用氯吡格雷、普拉格雷、替格瑞洛预处理的有效性及安全性,更好的为临床上NSTE-ACS患者介入前合理使用P2Y12受体拮抗剂提供循证医学依据及参考。方法:计算机检索PubMed、Embase、Web of science、ESCO、Cochrane Central Register of Controlled Trials,中国知网(CNKI)、维普医药信息资源系统(VIP)、万方数据库、SinoMed(CBM)。通过严格的文献筛选,纳入NSTE-ACS患者介入治疗前使用P2Y12受体拮抗剂预处理的随机对照试验(Randomized Controlled Trial,RCT)文献,下载全文并对文献质量进行严格评价后并提取数据,采用Stata 11.0及addis-1.16.6软件进行Meta分析。结果:共纳入14项临床随机对照研究(Randomized Controlled Trial,RCT),Meta分析显示主要心血管不良事件(Major Adverse Cardiovascular Event,MACE)事件的发生率,替格瑞洛与氯吡格雷存在差异(OR=0.51,95%CI:0.385~0.647,P<0.05),普拉格雷与氯吡格雷无明显差异(OR=1.058,95%CI:0.979~1.142,P>0.05),替格瑞洛与普拉格雷存在差异(OR=0.43,95%CI:0.28~0.66,P<0.05);出血事件的发生率,替格瑞洛与氯吡格雷存在差异(OR=1.548,95%CI:1.004~2.385,P<0.05),普拉格雷与氯吡格雷存在差异(OR=1.898,95%CI:1.557~2.315,P<0.05),替格瑞洛与普拉格雷无明显差异(OR=0.82,95%CI:0.30~2.09,P>0.05)。替格瑞洛与氯吡格雷的呼吸困难发生率存在差异(OR=3.766,95%CI:2.145~6.612,P<0.05),再发心肌梗死事件的发生率两者无明显差别(OR=0.517,95%CI:0.279~0.959,P>0.05)。结论:在NSTE-ACS患者PCI术前双联抗血小板预处理中,替格瑞洛预处理组的MACE发生率低于氯吡格雷预处理组,再发心肌梗死发生率两者相似,但呼吸困难、出血发生率替格瑞洛预处理组高于氯吡格雷预处理组;普拉格雷预处理组MACE发生率与氯吡格雷预处理组相似,出血发生率高于氯吡格雷预处理组;替格瑞洛预处理组MACE发生率低于普拉格雷预处理组,但出血事件的发生率两者相似。更多还原

【Abstract】 Objective:To systematically evaluate the efficacy and safety of pretreatment with clopidogrel,ticagrelor and prasugrel in patients with NSTE-ACS before interventional therapy,so as to provide evidence-based basis and reference for rational use of P2Y12 receptor antagonists in patients with NSTE-ACS before interventional therapy.Methods:PubMed,Embase,Web of science,ESCO,Cochrane Central Register of Controlled Trials,CNKI,VIP,Wanfang Database and SinoMed(CBM)were searched by computer.Through rigorous literature screening,randomized controlled trial(RCT)literatures of NSTE-ACS patients pretreated with P2Y12 receptor antagonists before intervention were included,the full text was downloaded,the literature quality was strictly evaluated,and the data were extracted,and meta-analysis was performed using Stata 11.0 and addis-1.16.6 software.Results:A total of 14 RCTs were included.Meta-analysis showed that the incidence of MACE events was different between ticagrelor and clopidogrel(OR = 0.51,95% CI: 0.385-0.647,P < 0.05).There was no significant difference between prasugrel and clopidogrel(OR = 1.058,95% CI: 0.979-1.142,P > 0.05).There was a difference between ticagrelor and prasugrel(OR = 0.43,P > 0.05).95% CI: 0.28-0.66,P < 0.05);the incidence of bleeding events was different between ticagrelor and clopidogrel(OR = 1.548,95% CI: 1.004-2.385,P < 0.05);there was a difference between prasugrel and clopidogrel(OR = 1.898,95% CI: 1.557-2.315,P < 0.05);there was no significant difference between ticagrelor and prasugrel(OR = 0.82,95% CI: 0.30-2.09,P > 0.05).There was a difference in the incidence of adverse events(OR=3.766,95% CI: 2.145-6.612,P<0.05)except bleeding between ticagrelor and clopidogrel,with no significant difference in the incidence of myocardial infarction events(OR=0.517,95% CI: 0.279-0.959,P>0.05).Conclusions:Ticagrelor is superior to clopidogrel in the incidence of dyspnea and hemorrhage,but superior to clopidogrel in the incidence of MACE and similar to clopidogrel in the incidence of myocardial infarction events in the pre-PCI anticoagulation treatment of NSTE-ACS patients;prasugrel is similar to clopidogrel in the incidence of MACE and higher than clopidogrel in the incidence of hemorrhage;Ticagrelor is superior to clopidogrel in the incidence of MACE.It was superior to prasugrel,but the incidence of bleeding events was not significantly different between the two drugs.更多还原