西洛他唑三聯療法治療PCI后再狹窄效果的Meta分析_《中國循證醫學雜志》

作者：

郭繼武 ^1,2 ,  馬彬 ¹ , 張宇龍 ^1,2 , 吳佳 ^1,2 , 周元媛 ^1,2 , 張小衛 ^1,3 , 楊克虎 ^1,3

1. 蘭州大學循證醫學中心，蘭州大學基礎醫學院（蘭州?730000）；2. 蘭州大學第二臨床醫學院（蘭州?730000）；3. 蘭州大學第一臨床醫學院（蘭州?730000）;

關鍵詞：

西洛他唑經皮冠狀動脈介入治療隨機對照試驗 Meta分析

DOI：

10.7507/1672-2531.20100525

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目的 ?系統評價西洛他唑三聯療法（西洛他唑+阿司匹林+氯吡格雷）治療PCI后再狹窄的有效性和安全性。
方法 ?計算機檢索Cochrane Library（2009年第3期）、PubMed（1966～2009）、EMbase（1974～2009）、CNKI（1994～2009）、CMB（1978～2009.2）、VIP（1989～2009.2）和中華醫學會數字化期刊庫（1998～2009）。由2名評價者按納入與排除標準獨立選擇試驗、評價質量并交叉核對，而后對同質研究采用RevMan 5.0軟件進行Meta分析。
結果 ?共納入5個RCT，包括2 348例患者。Meta分析結果顯示：與二聯療法（阿司匹林+氯比格雷）比較，西洛他唑三聯療法可以增加術后最小腔內直徑［MD=0.31，95%CI（0.11，0.51）］，降低再狹窄率［OR=0.49，95%CI（0.37，0.65）］和病死率［OR=0.52，95%CI（0.31，0.88）］；但在靶血管血運重建、中風和心悸發生率及主要不良心腦血管事件和心血管事件發生率方面，西洛他唑三聯療法和二聯療法之間并無明顯差異。
結論 ?目前的研究證據顯示，基于西洛他唑的三聯療法可以降低再狹窄的發生率，增加術后最小腔內直徑，且能降低病死率，值得臨床推廣應用。

引用本文： 郭繼武,馬彬,張宇龍,吳佳,周元媛,張小衛,楊克虎. 西洛他唑三聯療法治療PCI后再狹窄效果的Meta分析. 中國循證醫學雜志, 2010, 10(8): 952-956. doi: 10.7507/1672-2531.20100525 復制

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12.	Han Y, Li Y, Wang S, et al. Cilostazol in addition to aspirin and clopidogrel improves long-term outcomes after percutaneous coronary intervention in patients with acute coronary syndromes: a randomized, controlled study. Am Heart J, 2009, 157(4): 733-739.
13.	Douglas JS Jr, Holmes DR Jr, Kereiakes DJ, et al. Coronary stent restenosis in patients treated with cilostazol. Circulation, 2005, 112(18): 2826-2832.
14.	王守力, 韓雅玲, 荊全民, 等. 西洛他唑對冠狀動脈小血管病變支架術后患者的長期療效. 第四軍醫大學學報, 2005, 26(11): 994-997.
15.	蘆燕玲, 陳韻岱, 呂樹錚, 等. 西洛他唑預防老年冠心病患者冠狀動脈金屬裸支架術后再狹窄的療效. 中華老年醫學雜志, 2006, 25(7): 537-538.

1. Zijlstra F, de Boer MJ, Hoorntje JC, et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med, 1993, 328(10): 680-684.
2. Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA, 1997, 278(23): 2093-2098.
3. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet, 2003, 361(9351): 13-20.
4. Abbo KM, Dooris M, Glazier S, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol, 1995, 75(12): 778-782.
5. Resnic FS, Wainstein M, Lee MK, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J, 2003, 145(1): 42-46.
6. Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of ’no-reflow’ after percutaneous coronary intervention. Circulation, 1994, 89(6): 2514-2518.
7. Kozuma K, Hara K, Yamasaki M, et al. Effects of cilostazol on late lumen loss and repeat revascularization after Palmaz-Schatz coronary stent implantation. Am Heart J, 2001, 141(1): 124-130.
8. Yoon Y, Shim WH, Lee DH, et al. Usefulness of cilostazol versus ticlopidine in coronary artery stenting. Am J Cardiol, 1999, 84(12): 1375-1380.
9. Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation, 2001, 103(24): 3019-3041.
10. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. [www.cochrane-handbook.org/]. Accessed 10 March 2009.
11. Chen YD, Lu YL, Jin ZN, et al. A prospective randomized antiplatelet trial of cilostazol versus clopidogrel in patients with bare metal stent. Chin Med J (Engl), 2006, 119(5): 360-366.
12. Han Y, Li Y, Wang S, et al. Cilostazol in addition to aspirin and clopidogrel improves long-term outcomes after percutaneous coronary intervention in patients with acute coronary syndromes: a randomized, controlled study. Am Heart J, 2009, 157(4): 733-739.
13. Douglas JS Jr, Holmes DR Jr, Kereiakes DJ, et al. Coronary stent restenosis in patients treated with cilostazol. Circulation, 2005, 112(18): 2826-2832.
14. 王守力, 韓雅玲, 荊全民, 等. 西洛他唑對冠狀動脈小血管病變支架術后患者的長期療效. 第四軍醫大學學報, 2005, 26(11): 994-997.
15. 蘆燕玲, 陳韻岱, 呂樹錚, 等. 西洛他唑預防老年冠心病患者冠狀動脈金屬裸支架術后再狹窄的療效. 中華老年醫學雜志, 2006, 25(7): 537-538.

《中國循證醫學雜志》

西洛他唑三聯療法治療PCI后再狹窄效果的Meta分析

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《中國循證醫學雜志》

西洛他唑三聯療法治療PCI后再狹窄效果的Meta分析

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