摘要
目的系统评价普罗布考抗氧化作用及其预防再狭窄的效果,以观察其对动脉硬化进程的影响。方法采用Cochrane系统评价的方法,电子检索PubMed(1966~2007.9)、EMBASE(1980~2007.9)、Cochrane图书馆、中国生物医学文献数据库(1980~2007.9)和中国知网(CNKI)数据库(1994~2007.9),手工检索相关随机对照试验的参考文献。评价纳入研究的方法学质量,提取有效数据,采用RevMan4.2.10软件进行Meta分析。结果研究普罗布考改变氧化型低密度脂蛋白的Meta分析共纳入7个随机对照试验,276例患者,249例对照,标准化差值均数为-2.38,95%可信区间为(-3.39~-1.38);有4篇文献纳入改善血管内皮依赖舒张功能的Meta分析,共计96例患者,83例对照,标准化差值均数为1.97,95%可信区间为(0.60~3.35);有3篇文献(4个研究)纳入预防支架再狭窄管腔面积的Meta分析,共计159例患者,176例对照,权重差值均数为0.80,95%可信区间为(0.41~1.20);有7篇文献(11个研究)纳入预防支架再狭窄管腔直径的Meta分析,共计436例患者,420例对照,权重差值均数为0.32,95%可信区间为(0.22~0.42);有9篇文献(13个研究)纳入预防支架管腔再狭窄率的Meta分析,共计575例患者,557例对照,相对危险度为0.68,95%可信区间为(0.56~0.82);有4篇文献(5个研究)纳入普罗布考预防动脉粥样硬化不良事件率的Meta分析,共计253例患者,162例对照,相对危险度为0.60,95%可信区间为(0.39~0.92)。结论采用普罗布考治疗可以改善患者的氧化型低密度脂蛋白水平,维持支架内管腔面积和直径,降低其再狭窄率和不良事件的发生,但其抗氧化与控制动脉粥样硬化之间的关系仍需大样本的多中心随机对照试验进一步研究。
Aim To give an overview of the field of antioxidation and restenosis prevention with probucol, and investigate their potential use for the prevention of atherosclerosis progression. Methods A meta-analysis was performed by RevMan 4.2.10. We searched PubMed ( 1966 ~ 2007.9 ), EMBASE ( 1980 ~ 2007.9 ), :CBMDisc ( 1980 ~ 2007.9), CNKI( 1994 - 2007.9), the Cochrane Central Register of Controlled trials (CENTRAL, in the Cochrane Li- brary -Issue 3, 2007) and hand searched reference textbooks, articles and scientific proceedings. It was collected by Randomized controll trials ( RCT) and quasi-RCT to compare probucol with placebo and no treatment or other convention. Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed by using the fixed or random effects model after testing for heterogeneity. The results were expressed as weighted mean difference ( WMD ) or standardized mean difference ( SMD ) for continuous outcomes and relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). Results Seven studies involving 525 participants were identified for oxidized LDL levels. Average ox-LDL decreased significantly with probucol compared to placebo in all [ SMD - 2.38, 95% CI ( - 3.39 - - 1.38) ]. Four studies involving 179 participants were identified for flow-mediated vasodilation (FMD). Average FMD decreased significantly with probucol compared to placebo in all [ SMD 1.97, 95% CI (0.60 -3.35 ) ]. Four studies involving 335 participants were identified for lumen area ( LA ). Average LA decreased significantly with probucol compared to placebo in all [ WMD 0.80, 95% CI ( 0.41 - 1.20 ) ]. Similarly, eleven studies involving 856 participants were identified for minimal lumen diameter ( MLD ). Average MLD decreased significantly with probucol compared to placebo in all [ WMD 0.32, 95% CI (0.22 ~ 0.42) ]. The pooled result of 13 studies involving 1132 participants showed that incidence of restenosis might significantly decrease with RR [ 0.68, 95% CI (0.56 -0.82) ]. Similarly, six studies involving 415 participants showed that incidence of atherosclerosis-related events might significantly decrease with RR [ 0. 60, 95% CI (0.59 - 0.92) ]. Conelusion Probucol could decrease oxidized LDL levels, incidence of restenosis and atherosclerosis-related events and preserve minimal lumen diameter (MLD) and lumen area (LA) significantly. The antiatherosclerosis mechanism of probucol still needs to be studied in the current ongoing clinical trials.
出处
《中国动脉硬化杂志》
CAS
CSCD
2008年第10期781-786,共6页
Chinese Journal of Arteriosclerosis