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目的评价氯吡格雷治疗冠心病合并慢性肾病的疗效及安全性。方法计算机检索MEDLINE(1977-2009)、EMBASE(1989-2009)、Cochrane图书馆(2009年第6期)、中国生物医学文献光盘数据库(CBMd isc,1978-2009)和中国期刊网全文专题数据库(CNK I,1994-2009),并辅以手工检索,采用Cochrane协作网提供的RevM an 5.0软件进行M eta分析。结果经检索和筛选,将3篇随机对照试验(RCT)、质量为A级共29 858例患者,纳入本系统评价。结果显示,氯吡格雷可明显降低终点事件的发生,但增加出血的风险,差异有显著的统计学意义[(OR)=0.88,95%C I(0.82,0.95),P<0.01],[OR=1.59,95%C I(1.42,1.77),P<0.000 01]。慢性肾病(CKD)1、2期患者,治疗组比安慰剂组出现的终点事件减少。CKD 3期的患者,治疗组比安慰剂组终点事件发生率高,差异没有统计学意义[OR=1.12,95%C I(0.99,1.27),P=0.08]。CKD 1、2及3期的患者出血的发生率高于对照组。结论氯吡格雷治疗冠心病合并慢性肾病及CKD 1、2期的患者尽管出血风险增加了,但却降低了心血管死亡、心肌梗死或脑卒中终点事件的发生率;对于CKD 3期的患者,氯吡格雷治疗的终点事件的发生率增高,同时出血风险也增加,治疗上弊大于利,尽量避免使用。
Objective To evaluate the efficacy and safety of clopidogrel in the treatment of coronary heart disease complicated with chronic kidney disease. Methods The computer-based searches of MEDLINE (1977-2009), EMBASE (1989-2009), The Cochrane Library (2009), CBMD isc (1978-2009) and China Journal Net Full-text Thematic Database CNK I, 1994-2009) supplemented with manual retrieval and M eta analysis using RevM an 5.0 software from the Cochrane Collaboration. Results After searching and screening, 3 randomized controlled trials (RCTs) and 29 858 patients with quality grade A were enrolled in this systematic review. The results showed that clopidogrel significantly reduced the incidence of end-point events, but increased the risk of bleeding, the difference was statistically significant (OR = 0.88, 95% CI 0.82, 0.95, P <0.01) = 1.59, 95% CI (1.42, 1.77), P <0.000 01]. In patients with chronic kidney disease (CKD) stage 1 and stage 2, the endpoint in the treatment group was less than in the placebo group. Patients in the CKD stage 3 had a higher incidence of endpoints than placebo in the treatment group, with no significant difference [OR = 1.12, 95% C I (0.99, 1.27), P = 0.08]. The incidence of bleeding in patients with CKD stages 1, 2 and 3 was higher than that of controls. Conclusion Clopidogrel may reduce the risk of cardiovascular death, myocardial infarction or stroke in patients with CKD and CKD stage 1 and 2 despite the increased risk of bleeding. For patients with stage 3 CKD, The incidence of clopidogrel end point of treatment increased, while the risk of bleeding also increased, the treatment more harm than good, try to avoid using.