阿司匹林联合氯吡格雷对进展性卒中疗效、安全性以及血清hs-CRP影响的Meta分析
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摘要
目的系统评价阿司匹林联合氯吡格雷对进展性卒中疗效、安全性以及血清hs-CRP影响。方法检索中国知网、中国生物医学文献数据库、万方数据库、维普期刊数据库、PubMed、Embase、Cochrane Library 2013-2017年文献。根据Cochrane系统评价方法对纳入的研究进行质量评价,并用RevMan 5.3软件进行Meta分析。结果 23篇文献,共2 189例患者纳入统计分析。Meta分析显示:阿司匹林+氯吡格雷组治疗后患者的有效率明显高于阿司匹林组(OR=4.68,95%CI 3.54～6.19,P<0.000 01);神经功能缺损程度评分显著低于阿司匹林组(MD=-4.04, 95%CI-4.80～3.28,P<0.000 01);血清hs-CRP水平明显低于阿司匹林组(MD=-3.20, 95%CI-3.44～2.96,P<0.000 01);出血发生率高于阿司匹林组(OR=2.87, 95%CI 1.17～7.01,P=0.02)。结论阿司匹林联合氯吡格雷对进展性卒中疗效较好,但同时出血风险也高,应谨慎选择适应人群。
AIM To systematically evaluate the efficacy and safety of aspirin combined with clopidogrel(combination group) in the treatment of progressive stroke. METHODS The databases of CNKI,CBM,Wanfang,VIP,PubMed,Embase and Cochrane Library were searched from 2013 to 2017. The included studies were evaluated by the Cochrane system evaluation methods. Meta-analysis was conducted by RevMan 5.3 software. RESULTS A total of 23 studies, 2 189 patients were included in the meta-analysis. The results showed that the effective rate was higher in the combination group(OR=4.68,95% CI 3.54-6.19,P<0.000 01). The neurologic impairment score was significantly lower in the combination group(MD=-4.04,95%CI-4.80-3.28,P<0.000 01). Serum hs-CRP level was lower in the combination group after treatment(MD=-3.20,95%CI-3.44-2.96,P<0.000 01). However the incidence of hemorrhage was higher in the combination group(OR=2.87,95%CI 1.17-7.01,P=0.02). CONCLUSION Aspirin combined with clopidogrel is more efficacy in the treatment of progressive stroke, however the incidence of hemorrhage is also higher. It is important to recognize the eligible patients for the combination therapy.
AIM To systematically evaluate the efficacy and safety of aspirin combined with clopidogrel(combination group) in the treatment of progressive stroke. METHODS The databases of CNKI,CBM,Wanfang,VIP,PubMed,Embase and Cochrane Library were searched from 2013 to 2017. The included studies were evaluated by the Cochrane system evaluation methods. Meta-analysis was conducted by RevMan 5.3 software. RESULTS A total of 23 studies, 2 189 patients were included in the meta-analysis. The results showed that the effective rate was higher in the combination group(OR=4.68,95% CI 3.54-6.19,P<0.000 01). The neurologic impairment score was significantly lower in the combination group(MD=-4.04,95%CI-4.80-3.28,P<0.000 01). Serum hs-CRP level was lower in the combination group after treatment(MD=-3.20,95%CI-3.44-2.96,P<0.000 01). However the incidence of hemorrhage was higher in the combination group(OR=2.87,95%CI 1.17-7.01,P=0.02). CONCLUSION Aspirin combined with clopidogrel is more efficacy in the treatment of progressive stroke, however the incidence of hemorrhage is also higher. It is important to recognize the eligible patients for the combination therapy.
引文
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[7] 朱在勇,王进,周长文.拜阿司匹林联合氯吡格雷治疗进展性卒中99例临床观察[J].检验医学与临床,2012,9(5):585.
[8] 张德华.阿司匹林联合氯吡格雷治疗进展性卒中的疗效及其机制探讨[J].山东医药,2013,53(8):51.
[9] 黄迎秋.氯吡格雷联合阿司匹林治疗进展性脑卒中后的临床疗效[J].当代临床医刊,2014,27(5):1040.
[10] 黄丹翊,刘向娇.阿司匹林与氯吡格雷治疗进展性卒中的临床疗效分析[J].中外医疗,2014,33(30):8.
[11] 高辉.阿司匹林联合氯吡格雷治疗进展性卒中的疗效观察[J].现代诊断与治疗,2014,25(4):781.
[12] 潘莉,钟建,邓哲.阿司匹林联合氯吡格雷治疗进展性卒中患者的疗效及机制[J].河北医药,2014,36(18):2791.
[13] 邱麟,高正伟,罗志娟,等.阿司匹林联合氯吡格雷治疗进展性缺血性脑卒中的疗效及对hs-CRP水平的影响[J].临床军医杂志,2015,43(10):1043.
[14] 曹姗,董辉.阿司匹林联合氯吡格雷治疗进展性卒中50例[J].中国药业,2015,24(13):92.
[15] 熊培斌.阿司匹林联合氯吡格雷治疗进展性卒中的疗效及其机制探讨[J].临床医药文献电子杂志,2015,2(36):7440.
[16] 董占玲.阿司匹林联合氯吡格雷治疗60例进展性卒中的疗效及安全性[J].吉林医学,2015,36(10):2108.
[17] 刘志君,黄汉烽.氯吡格雷联合阿司匹林对进展性缺血性脑卒中患者神经功能及生活能力的影响[J].中国药物经济学,2016,11(5):41.
[18] 张光远.氯吡格雷联合拜阿司匹林抗血小板聚集治疗100例进展性卒中疗效观察[J].吉林医学,2016,37(4):881.
[19] 杨姝韬,孙连波,陈辉,等.阿司匹林联合氯吡格雷治疗进展性卒中患者的疗效及机制探析[J].中国继续医学教育,2016,8(10):122.
[20] 李兰红,王晋芳.阿司匹林联合氯吡格雷治疗急性进展性脑梗死的疗效观察[J].中西医结合心脑血管病杂志,2016,14(16):1926.
[21] 林彬武,吴明怀,林智强,等.阿司匹林联合氯吡格雷治疗进展型缺血性卒中的疗效分析[J].中国校医,2017,31(1):8.
[22] 朱祖建.阿司匹林联合氯吡格雷治疗进展性卒中的疗效及其机制研究[J].基层医学论坛,2016,20(27):3780.
[23] 郭志强.阿司匹林联合氯吡格雷治疗进展性卒中的疗效研究[J].北方药学,2017,14(8):30.
[24] 路燕.阿司匹林联合氯吡格雷治疗进展性卒中的疗效研究[J].现代诊断与治疗,2017,28(12):2194.
[25] 刘阿楠.阿司匹林联合氯吡格雷治疗进展性卒中的效果及机制探讨[J].河南医学研究,2017,26(5):862.
[26] 唐为成.阿司匹林联合氯吡格雷治疗进展性卒中的效果及其机制分析[J].中外医学研究,2017,15(24):153.
[27] 吴洁琼,李熠雯,洪宇.阿司匹林联合氯吡格雷治疗进展性缺血性脑卒中的临床疗效及安全性[J].临床合理用药杂志,2017,10(24):41.
[28] 石福宏.氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的疗效及对患者血清hs-CRP水平的影响[J].实用中西医结合临床,2017,17(5):41.
[29] 李凤芹.氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的效果观察[J].河南医学研究,2017,26(9):1645.
[30] OH M S,YU K H,LEE J H,et al.Aspirin resistance is associated with increased stroke severity and infarct volume[J].Neurology,2016,86(19):1808.
[31] GURIGIS M,THOMPSON P,JANSEN S.Review of aspirin and clopidogrel resistance in peripheral arterial disease[J].J Vasc Surg,2017,66(5):1576.
[32] PATGIRI D,PATHAK M S,SHARMA P,et al.Serum hs-CRP:a novel marker for prediction of cerebrovascular accidents (stroke) [J].J Clin Diagn Res,2014,8(12):8.
[2] JAUCH E C,SAVER J L,ADAMS H P,et al.Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2013,44(3):870.
[3] WANG Y,WANG Y,ZHAO X,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].J Vasc Surg,2015,132(1):40.
[4] SENERS P,TUREC G,OPPENHEIM C,et al.Incidence,causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke:a systematic review with pathophysiological implications[J].J Neurol Neurosurg Psychiatry,2015,86(1):87.
[5] YI X,WANG C,LIU P,et al.Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population[J].J Neurol,2016,263(8):1612.
[6] 脑卒中患者临床神经功能缺损程度评分标准(1995) [J].中华神经科杂志,1996,29(6):381.
[7] 朱在勇,王进,周长文.拜阿司匹林联合氯吡格雷治疗进展性卒中99例临床观察[J].检验医学与临床,2012,9(5):585.
[8] 张德华.阿司匹林联合氯吡格雷治疗进展性卒中的疗效及其机制探讨[J].山东医药,2013,53(8):51.
[9] 黄迎秋.氯吡格雷联合阿司匹林治疗进展性脑卒中后的临床疗效[J].当代临床医刊,2014,27(5):1040.
[10] 黄丹翊,刘向娇.阿司匹林与氯吡格雷治疗进展性卒中的临床疗效分析[J].中外医疗,2014,33(30):8.
[11] 高辉.阿司匹林联合氯吡格雷治疗进展性卒中的疗效观察[J].现代诊断与治疗,2014,25(4):781.
[12] 潘莉,钟建,邓哲.阿司匹林联合氯吡格雷治疗进展性卒中患者的疗效及机制[J].河北医药,2014,36(18):2791.
[13] 邱麟,高正伟,罗志娟,等.阿司匹林联合氯吡格雷治疗进展性缺血性脑卒中的疗效及对hs-CRP水平的影响[J].临床军医杂志,2015,43(10):1043.
[14] 曹姗,董辉.阿司匹林联合氯吡格雷治疗进展性卒中50例[J].中国药业,2015,24(13):92.
[15] 熊培斌.阿司匹林联合氯吡格雷治疗进展性卒中的疗效及其机制探讨[J].临床医药文献电子杂志,2015,2(36):7440.
[16] 董占玲.阿司匹林联合氯吡格雷治疗60例进展性卒中的疗效及安全性[J].吉林医学,2015,36(10):2108.
[17] 刘志君,黄汉烽.氯吡格雷联合阿司匹林对进展性缺血性脑卒中患者神经功能及生活能力的影响[J].中国药物经济学,2016,11(5):41.
[18] 张光远.氯吡格雷联合拜阿司匹林抗血小板聚集治疗100例进展性卒中疗效观察[J].吉林医学,2016,37(4):881.
[19] 杨姝韬,孙连波,陈辉,等.阿司匹林联合氯吡格雷治疗进展性卒中患者的疗效及机制探析[J].中国继续医学教育,2016,8(10):122.
[20] 李兰红,王晋芳.阿司匹林联合氯吡格雷治疗急性进展性脑梗死的疗效观察[J].中西医结合心脑血管病杂志,2016,14(16):1926.
[21] 林彬武,吴明怀,林智强,等.阿司匹林联合氯吡格雷治疗进展型缺血性卒中的疗效分析[J].中国校医,2017,31(1):8.
[22] 朱祖建.阿司匹林联合氯吡格雷治疗进展性卒中的疗效及其机制研究[J].基层医学论坛,2016,20(27):3780.
[23] 郭志强.阿司匹林联合氯吡格雷治疗进展性卒中的疗效研究[J].北方药学,2017,14(8):30.
[24] 路燕.阿司匹林联合氯吡格雷治疗进展性卒中的疗效研究[J].现代诊断与治疗,2017,28(12):2194.
[25] 刘阿楠.阿司匹林联合氯吡格雷治疗进展性卒中的效果及机制探讨[J].河南医学研究,2017,26(5):862.
[26] 唐为成.阿司匹林联合氯吡格雷治疗进展性卒中的效果及其机制分析[J].中外医学研究,2017,15(24):153.
[27] 吴洁琼,李熠雯,洪宇.阿司匹林联合氯吡格雷治疗进展性缺血性脑卒中的临床疗效及安全性[J].临床合理用药杂志,2017,10(24):41.
[28] 石福宏.氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的疗效及对患者血清hs-CRP水平的影响[J].实用中西医结合临床,2017,17(5):41.
[29] 李凤芹.氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的效果观察[J].河南医学研究,2017,26(9):1645.
[30] OH M S,YU K H,LEE J H,et al.Aspirin resistance is associated with increased stroke severity and infarct volume[J].Neurology,2016,86(19):1808.
[31] GURIGIS M,THOMPSON P,JANSEN S.Review of aspirin and clopidogrel resistance in peripheral arterial disease[J].J Vasc Surg,2017,66(5):1576.
[32] PATGIRI D,PATHAK M S,SHARMA P,et al.Serum hs-CRP:a novel marker for prediction of cerebrovascular accidents (stroke) [J].J Clin Diagn Res,2014,8(12):8.