本文選題：經(jīng)皮冠狀動脈介入治療 + 口服P2Y12抑制劑　； 參考：《廣西醫(yī)科大學(xué)》2016年碩士論文

【摘要】：研究背景指南均建議在急性冠脈綜合癥伴低出血風險患者,冠脈支架洗脫藥物(DES)植入術(shù)后必須雙重抗血小板治療至少1年。近期歐洲指南傾向于普拉格雷或者替格瑞洛加阿司匹林,而美國指南無傾向于哪一種,只表明可以互相替代。氯吡格雷本身是無活性的藥物前體,需要在體內(nèi)經(jīng)代謝后才能發(fā)揮抑制血小板聚集作用。因個體酶催化和代謝活性不同,故用藥存在較大個體差異,而新型口服P2Y12受體拮抗劑普拉格雷,與氯吡格雷相比,已被證實具有在體內(nèi)快速代謝,轉(zhuǎn)化為活性成分,發(fā)揮強大的抗血小板聚集作用。目前普拉格雷對急性冠脈綜合癥及擬行PCI患者的長期療效及安全性還未確切,待進一步研究。目的該研究的目的是系統(tǒng)性評價新型口服P2Y12抑制劑普拉格雷與氯吡格雷對急性冠脈綜合癥患者長期療效及安全性(≥1年)的Meta分析。方法計算機檢索PubMed, Web of Science, Cochrane Library, EMBASE, Clinical Trials.gov,中國學(xué)術(shù)文獻總庫、數(shù)字化期刊全文數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫、中文科技期刊數(shù)據(jù)庫中自建庫始至2016年5月發(fā)表的文獻,限定檢索范圍為"Observational Studies or Randomized controlled trials",并手工檢索相關(guān)文獻及各類會議摘要。由兩名研究員進行檢索,對符合要求的資料提取并采用RevMan5.3軟件進行Meta分析,最終共六項研究最終被納入,風險比(RRR)及置信區(qū)間(CI)用于評價全因死亡率、心肌梗死發(fā)生率、支架內(nèi)血栓發(fā)生率(擬行PCI)、大出血發(fā)生率及腦卒中發(fā)生率。結(jié)果與接受氯吡格雷治療相比,新型口服P2Y12抑制劑普拉格雷可有效降低支架內(nèi)血栓形成(Pooled RR:0.49；95% CI:0.37-0.65；P0.00001； 12=12%)發(fā)生率,但大出血發(fā)生率(Pooled RR:1.21；95% CI:1.01-1.44；P=0.04； I2=0%)高于接受氯吡格雷治療,而全因死亡率(Pooled RR:0.92；95% CI: 0.82-1.03；P=0.14；12=40%).心肌梗死發(fā)生率(Pooled RR:0.82；95% CI: 0.66-1.02；P=0.08；I2=64%)和腦卒中發(fā)生率(Pooled RR:0.85；95% CI: 0.68-1.07；P=0.16；I2=5%)均與接受氯吡格雷治療相同。結(jié)論普拉格雷顯著性降低支架內(nèi)血栓發(fā)生率,在全因死亡率、心肌梗死發(fā)生率及腦卒中發(fā)生率與氯吡格雷相似,但增加大出血發(fā)生率的風險。對于有活動性病理性出血或中風和／或TIA病史,不應(yīng)推薦普拉格雷。
[Abstract]:Background all guidelines recommend dual antiplatelet therapy for at least one year after coronary stent elution drug des implantation in patients with acute coronary syndrome with a low risk of bleeding. Recent European guidelines tend to be Pragrad or tigrlorogan aspirin, while the US guidelines do not tend to any of them, indicating only that they can replace each other. Clopidogrel is an inactive drug precursor and needs to be metabolized in vivo to inhibit platelet aggregation. Because of the difference of individual enzyme catalytic activity and metabolic activity, there is a great individual difference in drug use. Compared with clopidogrel, a new oral P2Y12 receptor antagonist, Pragray, has been proved to be fast metabolized in vivo and transformed into active components. Play a powerful role in anti-platelet aggregation. At present, the long-term efficacy and safety of Pragray in patients with acute coronary syndrome and planned PCI are uncertain and need further study. Objective to systematically evaluate the long-term efficacy and safety (鈮，

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