他汀类药物对血同型半胱氨酸水平影响的meta分析

Effect of statins on plasma homocysteine: a meta-analysis

目的探讨他汀类降脂治疗对血同型半胱氨酸水平的影响及其临床意义。方法计算机检索Pub Med、EMBASE、Cochrane图书馆、Medline、CNKI、中国生物医学文献数据库和维普中文科技期刊等数据库,检索时间从建库至2013年所有他汀类药物对血同型半胱氨酸（homocysteine,Hcy）影响的随机对照试验（RCTs）,由2名评价员独立筛选、评价文献和提取数据;应用系统评价软件R语言meta包对纳入研究进行加权定量合并,计算标准化均数差（standard mean difference,SMD）和95%CI,并绘制漏斗图来明确有无发表性偏倚。结果共纳入26篇文献,32个研究,共计患者2 451例。他汀类药物对Hcy影响的Meta分析结果显示：与对照组相比,治疗组（在前者基础上加用他汀类药物）他汀类药物具有明显降Hcy作用（SWD=1.41,95%CI：1.04~1.78,P〈0.001）;对不同他汀类药物进行亚组meta分析,提示各亚组效应与总效应方向一致。结论他汀类药物能有效地降低患者的Hcy水平。

Objective To assess the influence and clinical significance of statins on plasma homocysteine. Methods Randomized controlled trials（ RCT s） about the relationship between statins and plasma homocysteine were searched from Pub Med,EMBASE,Cochrane L ibrary,Medline,CNKI,Sino Med,VIP and other databases before December 12 2013. T he qualified literatures were selected and reviewed by two independent reviewers,then the extracted data from selected literatures were analyzed by using meta package of the R software. Meta-analysis of standard mean difference（ SWD） and 95% CI were used to quantify the mean difference between treatment group and control group. The publication bias was evaluated by funnel plots. Results Thirty two studies involving 2451 patients were included. The results of meta-analyses showed that compared to control group,plasma homocysteine levels in treatment group（ using statins） were reduced（ SW D = 1. 41,95 %C I： 1. 04-1. 78）; and the curativ e effect of different statins sho wed the sim ilar results as the overall effect of statins. Conclusion Statins can effectiv ely reduce the plasm a homocy steine levels o f patients.