摘要
目的分析联合PCSK9抑制剂对冠心病患者经皮冠状动脉介入治疗(PCI)术后的有效性和安全性。方法计算机检索中文数据库(中国知网、万方数据库)和英文数据库(PubMed、Cochrane Library),搜索建库至2023年1月冠心病患者行PCI采用PCSK9抑制剂的随机对照试验。按照Cochrane系统评价要求制定纳纳入和排除标准,提取患者基本资料。采用RevMan 5.4软件比较联合PCSK9抑制剂对冠心病患者PCI术后的心肌梗死、卒中、因不稳定心绞痛再入院、不良反应的发生情况,以及治疗前后血脂水平、炎性细胞因子水平变化情况。结果纳入文献共8篇,包含患者17896例。与标准治疗组比较,PCSK9抑制剂组PCI术后心肌梗死[比值比(OR)=0.69,95%置信区间(95%CI):0.60~0.80,P<0.01]、因不稳定心绞痛再入院(OR=0.27,95%CI:0.10~0.75,P=0.01)、卒中(OR=0.73,95%CI:0.57~0.94,P=0.01)的发生率均明显低于标准治疗组;PCSK9抑制剂组患者治疗后的低密度脂蛋白胆固醇[均数差(MD)=-0.96,95%CI:-1.07~-0.86,P<0.01]、甘油三酯(MD=-0.23,95%CI:-0.35~-0.10,P<0.01)、白细胞介素-6[标准化均数差(SMD)=-0.63,95%CI:-0.86~-0.40,P<0.01]、超敏C反应蛋白(SMD=-0.98,95%CI:-1.22~-0.74,P<0.01)水平降低,且均低于标准治疗组;而两组心源性死亡、不良反应发生率比较差异无统计学意义(P>0.05)。结论PCI术后联合PCSK9抑制剂治疗的临床效果更优,而心源性死亡发生率、不良反应发生率与常规治疗无明显差异。
Objective To analyze the effectiveness and safety of combined PCSK9 inhibitors in patients with coronary heart disease following percutaneous coronary intervention(PCI).Methods Chinese databases(CNKI,Wanfang database)and English databases(PubMed,Cochrane Library)were searched using computer-based searches.Randomized controlled trials of PCSK9 inhibitors in patients with coronary heart disease undergoing PCI were searched from the establishment of the databases until January 2023.The inclusion and exclusion criteria were formulated in accordance with the requirements of the Cochrane systematic review,and the basic data of the patients were extracted.RevMan 5.4 software was utilized to compare the occurrence of myocardial infarction,stroke,rehospitalization due to unstable angina pectoris,adverse reactions,and alterations in blood lipid levels and inflammatory cytokine levels before and after treatment in patients with coronary heart disease who were also administered PCSK9 inhibitors after PCI.Results A total of 8 articles were included,including 17896 patients.Compared with the standard treatment group,the incidences of myocardial infarction(OR=0.69,95%CI:0.60-0.80,P<0.01),re-admission due to unstable angina pectoris(OR=0.27,95%CI:0.10-0.75,P=0.01),and stroke(OR=0.73,95%CI:0.57-0.94,P=0.01)in the PCSK9 inhibitor group were significantly lower than those in the standard treatment group.After treatment,the levels of low-density lipoprotein cholesterol(MD=-0.96,95%CI:-1.07--0.86,P<0.01),triglyceride(MD=-0.23,95%CI:-0.35--0.10,P<0.01),interleukin-6(SMD=-0.63,95%CI:-0.86--0.40,P<0.01),and hypersensitive C-reactive protein(SMD=-0.98,95%CI:-1.22--0.74,P<0.05)in the PCSK9 inhibitor group were lower than those in the standard treatment group.There was no significant difference in the incidence of cardiac death and adverse reactions between the two groups(P>0.05).Conclusion The clinical effect of combined PCSK9 inhibitor therapy after PCI is superior,but there is no significant difference in the incidence of cardiac death and adverse reactions compared to conventional treatment.
作者
王凡
李庆勇
牛锁成
陈雪斌
汪凤兰
郭凌
刘宇捷
WANG Fan;LI Qingyong;NIU Suocheng;CHEN Xuebin;WANG Fenglan;GUO Ling;LIU Yujie(Graduate School of Xinxiang Medical College,Xinxiang,Henan 453000,China;Puyang People’s Hospital Affiliated to Xinxiang Medical College,Puyang,Henan 457000,China)
出处
《重庆医学》
CAS
2023年第16期2512-2518,共7页
Chongqing medicine
基金
河南省医学科技攻关计划项目(LHGJ20221013)。
作者简介
王凡(1997-),在读硕士研究生,主要从事冠心病的诊断与治疗相关研究;通信作者:李庆勇,E-mail:mdlqy@qq.com。
