不同剂量阿托伐他汀治疗慢性硬膜下血肿的疗效和安全性的meta分析

Meta-analysis of the efficacy and safety of different doses of atorvastatin for chronic subdural hematoma

目的探讨不同剂量阿托伐他汀治疗慢性硬膜下血肿(CSDH)的疗效和安全性,为临床治疗提供循证参考。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、CBM、CNKI、维普和万方等数据库,收集不同剂量阿托伐他汀治疗慢性硬膜下血肿的随机对照试验,检索时限均为从建库至2022年1月。对纳入研究的质量进行评价,然后使用RevMan 5.4软件和GEMTC软件进行直接和网络meta分析。结果共纳入有效文献14篇,累计1519名患者,直接meta分析的结果显示:①治疗后日常生活活动能力(ADL)评分方面,40 mg较20 mg阿托伐他汀疗效更显著(P<0.05),而20 mg较10 mg阿托伐他汀疗效无明显差异(P=0.57);②复发率方面,40 mg较20 mg阿托伐他汀更低(P=0.008);③神经功能恢复方面,20 mg阿托伐他汀组较未使用阿托伐他汀组疗效更显著(P=0.006),阿托伐他汀网状meta分析的结果显示:在总有效率方面,40 mg最佳,其次为20 mg,最后是10 mg;在不良反应发生方面40 mg最高,其次为20 mg,最后是10 mg。结论在不同剂量的阿托伐他汀中,40 mg在有效性、ADL评分、复发率方面均优于其他低剂量,但药物不良反应发生率也更高。

Objective To determine the efficacy and safety of different doses of atorvastatin for chronic subdural hematoma(CSDH),and to provide evidence-based reference for clinical treatment.Methods The databases of PubMed,Embase,Web of Science,Cochrane Library,CBM,CNKI,VIP and Wanfang were searched.The randomized controlled trials of different doses of atorvastatin for chronic subdural hematoma were collected from the establishment of the databases to January 2022.The quality of the included research was evaluated.RevMan 5.4 software and GEMTC software were used for the direct and network meta-analysis.Results Totally 14 valid literatures involving 1519 patients were included.The direct meta-analysis showed that:①40 mg atorvastatin had better effect than that of 20 mg in activities daily living(ADL)after the treatment,but there was no significant difference between 20 mg and 10 mg atorvastatin(P=0.57).②In terms of recurrence rate,40 mg atorvastatin was lower than 20 mg,and the difference was significant(P=0.008).③In terms of neurological recovery,the 20 mg atorvastatin group had a more significant effect than the non-atorvastatin group,with significant difference(P=0.006).The network meta-analysis showed that atorvastatin had a significant effect on the total effective rate:40 mg was the best,followed by 20 mg,and 10 mg respectively.As to adverse reactions,40 mg was the highest,followed by 20 mg,and 10 mg respectively.Conclusion Among different doses of atorvastatin,40 mg is better than other lower doses in effectiveness,ADL score and recurrence rate,but the incidence of adverse drug reactions is also higher.