Liang Li-Rong, Ma Qian, Feng Lin, Qiu Qi, Zheng Wen, Xie Wu-Xiang
Department of Clinical Epidemiology & Tobacco Dependence Treatment Research, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
World J Diabetes. 2020 Apr 15;11(4):137-149. doi: 10.4239/wjd.v11.i4.137.
Previous studies have shown that patients with diabetes mellitus (DM) respond poorly to clopidogrel treatment.
To systematically evaluate the efficacy of clopidogrel for the treatment of acute coronary syndromes or ischemic stroke in patients with or without DM.
PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE were searched from 1980 on 27 June 2019 to identify relevant randomized controlled trials that compared the effect of a combination of clopidogrel and aspirin with aspirin alone. A random-effects meta-analysis was used to estimate the hazard ratio (HR) and its 95% confidence interval (CI). Sensitivity analysis was performed using a fixed-effect model. The statistic was used to evaluate the heterogeneity of the study data.
Six randomized controlled trials, comprising 43352 participants (13491 with and 29861 without DM) who had received antiplatelet therapy for ≥ 3 mo, were included in the meta-analysis. Compared with aspirin alone, a combination of clopidogrel and aspirin significantly reduced the risk of any cardiovascular event in patients without DM (HR = 0.78, 95%CI: 0.71-0.86, < 0.001; = 23%, = 0.26). Clopidogrel plus aspirin also significantly reduced cardiovascular risk in patients with DM, although the effect was smaller (HR = 0.89, 95%CI: 0.81-0.99, = 0.030; = 0%, = 0.74). Nevertheless, there was no significant difference in the efficacy of clopidogrel at reducing the risk of cardiovascular events in patients with DM those without ( for interaction = 0.062).
Thus, the present study shows that the addition of clopidogrel to aspirin significantly lowers cardiovascular risk in patients with or without DM who have experienced ischemic cardiovascular disease. The beneficial effect of the addition of clopidogrel to aspirin for patients with DM was lower than that in patients without DM, although the modifying effect of DM did not reach significance.
既往研究表明，糖尿病（DM）患者对氯吡格雷治疗反应不佳。
系统评价氯吡格雷治疗合并或不合并DM的急性冠脉综合征或缺血性卒中患者的疗效。
检索1980年至2019年6月27日的PubMed、Cochrane对照试验中心注册库和EMBASE，以确定比较氯吡格雷与阿司匹林联合用药和单用阿司匹林效果的相关随机对照试验。采用随机效应荟萃分析估计风险比（HR）及其95%置信区间（CI）。使用固定效应模型进行敏感性分析。采用I²统计量评估研究数据的异质性。
荟萃分析纳入了6项随机对照试验，共43352例参与者（13491例合并DM，29861例未合并DM），这些参与者接受抗血小板治疗≥3个月。与单用阿司匹林相比，氯吡格雷与阿司匹林联合用药显著降低了未合并DM患者发生任何心血管事件的风险（HR = 0.78，95%CI：0.71 - 0.86，P < 0.001；I² = 23%，P = 0.26）。氯吡格雷加阿司匹林也显著降低了合并DM患者的心血管风险，尽管效果较小（HR = 0.89，95%CI：0.81 - 0.99，P = 0.030；I² = 0%，P = 0.74）。然而，氯吡格雷在降低合并DM患者心血管事件风险方面的疗效与未合并DM患者相比无显著差异（交互作用P = 0.062）。
因此，本研究表明，在经历过缺血性心血管疾病的合并或未合并DM的患者中，阿司匹林联合氯吡格雷可显著降低心血管风险。对于合并DM的患者，阿司匹林联合氯吡格雷的有益效果低于未合并DM的患者，尽管DM的修饰作用未达到显著水平。
