| 高燕,曹剑,卢学春,刘先锋,马聪,范利.老年冠心病患者联用他汀对氯吡格雷疗效的影响:回顾性队列研究[J].Chinese journal of Epidemiology,2012,33(3):337-341 |
| 老年冠心病患者联用他汀对氯吡格雷疗效的影响:回顾性队列研究 |
| Comparison on the effects of clopidogrel, statins combination in treating coronary artery disease among the elderly patients: a retrospective cohort study |
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| DOI： |
| KeyWord: 冠心病 老年患者 氯吡格雷 他汀 队列研究 |
| English Key Word: Coronary artery disease Elderly patients Clopidogrel Statins Retrospective cohort study |
| FundProject:国家科技支撑计划(2009BAI86B04) |
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| Abstract: |
| 目的 比较老年冠心病患者单用氯吡格雷与氯吡格雷联用不同代谢途径他汀的疗效.方法 入选1021例2000年1月至2011年2月服用氯吡格雷的老年冠心病患者,其中单用氯吡格雷178例,氯吡格雷联用他汀843例[经细胞色素P-450家族3A亚家族多肽4(CYP3A4)代谢的他汀636例和非CYP3A4代谢他汀207例).研究主要终点为随访期内全因死亡,次要终点为心绞痛或心肌梗死再入院、血管再通术(冠状动脉介入治疗或冠状动脉搭桥术)、脑卒中和短暂性脑缺血发作.结果 单用氯吡格雷组和氯吡格雷联用他汀组发病密度(全因死亡)分别是6.86‰和3.18‰,RR=2.15 (95％CI:1.39～ 3.33),两组全因死亡率比较差异有统计学意义(x2=3.53,P＜0.01)；终点事件发生率比较差异无统计学意义(P＞0.05)；对所有混杂因素倾向评分后,按1∶1匹配,氯吡格雷联用他汀组较单用氯吡格雷组明显降低全因死亡率,RR=0.42(95％CI:0.19～ 0.93),差异有统计学意义(x2＝7.23,P＜0.01)；不同代谢途径他汀匹配前后全因死亡率及终点事件发生率比较,差异无统计学意义(P＞0.05).结论 老年冠心病患者氯吡格雷联用他汀的全因死亡率明显低于单用氯吡格雷；而不同代谢途径他汀(经CYP3A4途径代谢和不经CYP3A4途径代谢)对死亡率及不良事件发生率影响的差异无统计学意义. |
| English Abstract: |
| Objective To compare the effects of clopidogrel with or without combined with CYP3A4-metabolized statin in treating coronary artery disease (CAD) among the elderly patients.Methods The study cohort was defined as all patients were over 60 years of age and hospitalized for CAD who were prescribed clopidogrel between January 2000 and February 201 1.A total of 1021 patients were enrolled,with 178 of them prescribed clopidogrel and 843 patients were administrated clopidogrel combined with statins (CYP3A4-metabolized statins 636 and non CYP3A4-metabolized statins 207).The primary endpoint was all cause of death and the second endpoint were non-fatal myocardial infarction (MI),but hospitalized for unstable angina,stroke,transient ischemic attack,or repeated revascularization (PCI or coronary artery bypass graft).Results Among the clopidogrel group and the clopidogrel plus statins group,the incidence density of death was 6.86/1000 and 3.18/ 1000 respectively,with crude RR as 2.15(95％CI:1.39-3.33) and statistically significant (x2=3.53,P＜0.01).The incidence density of composite thromboembolic events did not show statistical significance (P＞0.05).The two groups were 1∶1 matched,after propensity score matching,clopidogrel coadministrated with statins group showed significant decrease in all cause of death,with RR as 0.42 (95％ CI:0.19-0.93),x2=7.23,P＜0.01.No significant difference was observed in deaths or composite thromboembolic events between statins via different cytochrome P450 pathways.Conclusion Clopidogrel with statin could reduce the mortality of elderly CAD patients compared with clopidogrcl without statin.The result did not show statistical significance between CYP3A4-metabolized statins or non CYP3A4-metabolized statins regarding the mortality or composite endpoint events.? |
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