目的 评价CYP2C19基因型检测指导氯吡格雷个体化治疗缺血性脑卒中的有效性和安全性.方法 全面检索PubMed、Embase、Cochrane Library、Web of Science、Clinical Trail、中国生物医学文献服务系统数据库(CBM)、中国知网、万方与维普数据库,检索时间从建库至2023年8月,收集CYP2C19基因型检测指导氯吡格雷抗血小板治疗缺血性脑卒中患者的随机对照试验(RCT).采用RevMan5.3软件进行meta分析.结果 共纳入11项RCT,8729例缺血性脑卒中患者.meta分析结果显示,基于CYP2C19基因型检测指导氯吡格雷个体化抗血小板治疗与常规抗血小板治疗方案比较,两组患者脑卒中复发率[OR=0.48,95％CI:0.28～0.83,P=0.008]、心血管事件发生率[OR=0.52,95％CI:0.33～0.82,P=0.005]、全因死亡率[OR=0.57,95％CI:0.31～1.06,P=0.070]差异有统计学意义.安全性方面,两组患者出血事件发生率[OR=1.16,95％CI:0.53～2.50,P=0.710]差异无统计学差异.结论 基于现有的证据,CYP2C19基因型检测指导氯吡格雷个体化抗血小板治疗缺血性脑卒中较常规抗血小板治疗可明显降低脑卒中复发率及血管事件发生率,且不增加出血事件的发生风险.
Abstract
Objective To assess the effectiveness and safety of CYP2C19 genotype test to guide clopi-dogrel individualized therapy in treating ischemic stroke.Methods The databases of PubMed,Embase,Co-chrane Library,Web of Science,Clinical Trail,CBM,CNKI,Wanfang database and VIP database were compre-hensively retrieved.The retrieval time was from the database establishment to August 2023.The randomized controlled trials (RCT) of CYP2C19 gene guiding clopidogrel anti-platelet therapy in the patients with ische-mic stroke were collected.The meta analysis was conducted by adopting the RevMan 5.3 software.Results A total of eleven RCT and 8729 patients with ischemic stroke were included.The meta analysis results showed that there was statistically significant difference in the recurrence rate risk of stroke (OR=0.48,95％CI:0.28-0.83,P=0.008),cardiovascular events incidence rate (OR=0.52,95％CI:0.33-0.82,P=0.005) and incidence rate of all-cause death (OR=0.57,95％CI:0.31-1.06,P=0.070) between clopidogrel individ-ualized anti-platelet treatment based on CYP2C19 genotype detection guidance and conventional anti-platelet treatment.In terms of safety,there were no statistically significant difference in the incidence rate of bleeding between the two groups (OR=1.16,95％CI:0.53-2.50,P=0.710).Conclusion CYP2C19 genotype detec-tion guided clopidogrel personalized anti-platelet therapy could significantly reduce the recurrent rate of stroke and incidence rate of vascular events compared with conventional anti-platelet treatment based on the existing evidence,moreover without increasing the risk of bleeding event occurrence
维普
万方数据