目的 系統(tǒng)評價替格瑞洛聯(lián)用替羅非班用于中國急性冠脈綜合征（ACS）患者經(jīng)皮冠狀動脈介入術(shù)（PCI）的有效性和安全性，為臨床治療提供循證醫(yī)學(xué)證據(jù)。方法 檢索中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、萬方數(shù)據(jù)庫（Wanfang Data）、維普中文期刊全文數(shù)據(jù)庫（VIP）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、PubMed、EMBmbase、The Cochrance Library數(shù)據(jù)庫，檢索時間均為建庫至2020年12月，搜集替格瑞洛聯(lián)合替羅非班用于中國ACS患者PCI術(shù)后的臨床隨機(jī)對照試驗(yàn)（RCT）。提取資料并采用改良Jadad量表評價質(zhì)量，采用RevMan 5.3軟件進(jìn)行Meta分析。結(jié)果 納入17篇RCTs，1 974例患者。Meta分析結(jié)果顯示，與對照組比較，替格瑞洛聯(lián)用替羅非班組患者主要不良心血管事件（MACE）［RR=0.28，95% CI=（0.21，0.37），P<0.01］、血小板聚集率［MD=-6.91，95% CI=（-8.35，-5.46），P<0.01］顯著減少，左心室射血分?jǐn)?shù)（LVEF）［MD=6.05，95% CI=（5.39，6.71），P<0.01］和術(shù)后血流TIMI分級3級率［RR=1.18，95% CI=（1.12，1.25），P<0.01］顯著增加，同時出血發(fā)生率［RR=1.18，95% CI=（0.86，1.61），P=0.30］未明顯增加。結(jié)論 替格瑞洛諾聯(lián)合替羅非班用于中國ACS患者PCI術(shù)后的有效性優(yōu)于替格瑞洛、替羅非班單用及氯吡格雷聯(lián)用替羅非班，且并未增加出血發(fā)生率。

Objective To systematically evaluate of the efficacy and safety of ticagrelor combined with tirofiban in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) in China, to provide evidence-based medicine for clinical treatment. Methods The randomized controlled trials (RCT) about ticagrelor combined with tirofiban in ACS patients after PCI in China in databases of CNKI, VIP, CBM, Wanfang, PubMed, EMBmbase, and The Cochrance Library were collected from the establishment of the database to December 2020. The data extraction and quality evaluation with modified Jadad scale, Metaanalysis was performed by using RevMan 5.3 software. Results A total of 17 RCTs with 1 974 patients were enrolled. Meta-analysis showed that compared with the control group, the ticagrelor combined with tirofiban had the reduced incidences of major adverse cardiac events (MACE)[RR=0.28, 95%CI=(0.21, 0.37), P < 0.01] and platelet aggregation rate[MD=-6.91, 95%CI=(-8.35, -5.46), P < 0.01], significant increase left ventricular ejection fraction (LVEF)[MD=6.05, 95%CI=(5.39, 6.71), P < 0.01] and postoperative blood flow TIMI grade 3[RR=1.18, 95%CI=(1.12, 1.25), P < 0.01], meanwhile did not significantly increase the incidence of bleeding[RR=1.18, 95%CI=(0.86, 1.61), P=0.30]. Conclusion The effectiveness of ticagrelor combined with tirofiban in Chinese ACS patients after PCI is better than that of ticagrelor, tirofiban and clopidogrel combined with tirofiban, and not increase the incidence of bleeding.

R972

河北省醫(yī)學(xué)科學(xué)研究課題資助項(xiàng)目（20191767）