本文選題：房顫　切入點(diǎn)：慢性腎病　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的：慢性腎病會增加非瓣膜性房顫患者的血栓風(fēng)險(xiǎn)。新型口服抗凝藥物(達(dá)比加群、阿哌沙班、利伐沙班)已被批準(zhǔn)用于非瓣膜性房顫合并慢性腎病病人的卒中預(yù)防。然而,腎功能不全有可能改變新型口服抗凝藥物的抗凝效果并增加出血風(fēng)險(xiǎn)。本文用系統(tǒng)綜述和間接Meta分析的方法,研究新型口服抗凝藥物與華法林在治療非瓣膜性房顫合并慢性腎病病人的有效性和安全性的比較。 方法：利用計(jì)算機(jī)檢索Pubmed, ISI Web of Science, Cochrane圖書館臨床對照試驗(yàn)數(shù)據(jù)庫,同時(shí)通過手工檢索相關(guān)系統(tǒng)評價(jià)的參考文獻(xiàn)作為補(bǔ)充。檢索日期為自建庫至2015年4月23日。檢索已公開發(fā)表的隨機(jī)對照研究。研究的干預(yù)與對照分別為三種新型口服抗凝藥物(達(dá)比加群、阿哌沙班、利伐沙班)和華法林中的一種。觀測的結(jié)局指標(biāo)包括：全因死亡率、顱內(nèi)出血、大出血和體循環(huán)栓塞及卒中。應(yīng)用R軟件中的meta和netmeta程序包進(jìn)行間接Meta分析。 結(jié)果：共納入4個(gè)研究,包括9776例患者。其中利伐沙班與華法林比較的文獻(xiàn)2篇,阿哌沙班與華法林比較的文獻(xiàn)1篇,達(dá)比加群與華法林比較的文獻(xiàn)1篇。對于非瓣膜性房顫合并慢性腎病的病人,傳統(tǒng)Meta分析結(jié)果顯示新型口服抗凝藥物在降低房顫合并慢性腎病患者的體循環(huán)栓塞和卒中的發(fā)生率方面不劣于華法林,且不增加其全因死亡率、大出血及顱內(nèi)出血發(fā)生率。間接Meta分析結(jié)果顯示利伐沙班、達(dá)比加群和阿哌沙班在預(yù)防卒中和體循環(huán)栓塞方面并無顯著差異,阿哌沙班相比于達(dá)比加群和利伐沙班大出血風(fēng)險(xiǎn)較低。 結(jié)論：在非瓣膜性房顫合并慢性腎病患者,新型口服抗凝藥在降低卒中及體循環(huán)栓塞方面不劣于華法林,且不增加出血風(fēng)險(xiǎn)。阿哌沙班相比于達(dá)比加群和利伐沙班大出血較低。目前仍需大樣本、多中心的高質(zhì)量研究,為達(dá)比加群、阿哌沙班、利伐沙班這三類藥物對非瓣膜性房顫合并腎功能不全患者全因死亡率、大出血和體循環(huán)栓塞及卒中等終點(diǎn)提供進(jìn)一步證據(jù)。
[Abstract]:Objective: chronic kidney disease increases in patients with non valvular atrial fibrillation risk of thrombosis. The new oral anticoagulant (dabigatran, this drug Shaaban, Shaaban Lee Laval) has been approved for stroke in nonvalvular atrial fibrillation in patients with chronic kidney disease prevention. However, renal insufficiency may change the new oral anticoagulants the effect of anticoagulant therapy and increase the risk of bleeding. Analysis method of systematic review and indirect Meta this paper, to compare the efficacy and safety of new oral anticoagulants with Hua Falin in the treatment of non valvular atrial fibrillation in patients with chronic kidney disease.
Methods: the Pubmed database using the computer, ISI Web of Science, clinical controlled trials database of Cochrane library, at the same time through the manual retrieval system evaluation related references as a supplement. Retrieval date from setting up to April 23, 2015. Randomized controlled study has been published in retrieval. Intervention and control study were three new oral anticoagulants (Darby with this drug group, Shaaban, Lee and Shaaban) of a warfarin. Including the outcome observation: all-cause mortality, intracranial hemorrhage, bleeding and systemic embolism and stroke. Application of R software in the meta and netmeta package for indirect Meta analysis.
Results: a total of 4 studies were included, involving 9776 patients. Among them Shaaban Lee Laval with warfarin compared with 2 references, a comparison of Shaaban and warfarin 1 literatures, dabigatran and warfarin compared with 1 literatures. For non valvular atrial fibrillation in patients with chronic kidney disease patients, the traditional Meta analysis results showed that new oral anticoagulants in the incidence of noninferior to warfarin for atrial fibrillation and reduce systemic embolism in patients with chronic kidney disease and stroke, and no increase in all-cause mortality, hemorrhage and incidence of intracranial hemorrhage. The results of indirect Meta analysis showed that dabigatran and rivaroxaban, this drug in the prevention of stroke and no Shaaban systemic embolism significantly different, with a Shaaban compared to dabigatran and cutting Shaaban hemorrhage risk is low.
Conclusion: Patients with chronic kidney disease in non valvular atrial fibrillation, the new oral anticoagulants in reducing stroke and systemic embolism is not inferior to warfarin, without increasing the risk of bleeding. This drug compared to Shaaban and Shaaban Lee of dabigatran bleeding is low. There is still need a large sample of high quality the center for dabigatran, O, of Shaaban, Lee Shaaban of these three types of drugs on renal function in non valvular atrial fibrillation in patients with and without all-cause mortality, hemorrhage and systemic embolism and stroke end point to provide further evidence.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R541.75;R692

【共引文獻(xiàn)】

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1 吳青;高霏;趙迎新;;老年冠心病合并房顫患者行經(jīng)皮冠狀動(dòng)脈介入治療術(shù)后的抗栓治療策略及安全性[J];世界臨床藥物;2013年12期

2 焦昌安;石文蕾;張煜;邱朝暉;郭新貴;;兩種卒中風(fēng)險(xiǎn)評估系統(tǒng)對非瓣膜性房顫人群評估結(jié)果的比較[J];重慶醫(yī)學(xué);2013年32期

3 趙森;秦明照;;慢性腎臟病合并血脂異常的他汀類藥物干預(yù)[J];中國醫(yī)藥導(dǎo)刊;2014年03期

4 張鋼;蔣電明;;雙磷酸鹽藥物與心房顫動(dòng)的相關(guān)性研究進(jìn)展[J];重慶醫(yī)學(xué);2014年16期

5 李纓;王蕾;湯詠梅;賈慧;金惠良;葉娟;顧明穎;徐榮;顧韌紅;邵月琴;;上海市嘉定區(qū)慢性腎臟病的流行病學(xué)研究[J];分子影像學(xué)雜志;2014年02期

6 黃劍華;覃秀先;龍鳳川;韓國橋;韋聯(lián)章;;廣西鳳山縣壯族農(nóng)村慢性腎臟病的橫斷面流行病學(xué)調(diào)查[J];廣西醫(yī)科大學(xué)學(xué)報(bào);2014年03期

7 羅華麗;蔣先洪;文津;馬艷萍;夏慶紅;黎洋;胡煜琳;孫Rσ，

本文編號：1637042