不同剂量阿托伐他汀对国人颈动脉粥样硬化影响的Meta分析

Meta-analysis on influence of different doses of atorvastatin on carotid atherosclerosis in Chinese

目的:分析不同剂量阿托伐他汀对国人颈动脉粥样硬化及缺血性脑卒中的影响,寻求安全有效的、适合中国人群应用的阿托伐他汀剂量,为预防缺血性脑卒中提供理论依据。方法:计算机检索PubMed、Medline、中国知网、维普中文科技期刊和中国生物医学文献数据库等在1990—2011年关于阿托伐他汀在脑卒中应用的随机对照试验(RCTs)文章,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Revman5.0及SPSS 13.0计算相关指标绘制图表,并针对不同剂量阿托伐他汀对颈动脉内膜中层厚度(IMT)、低密度脂蛋白胆固醇(LDL-C)和不良反应的影响进行Meta分析。结果:中国人群普遍的阿托伐他汀应用剂量为10和20mg,大剂量阿托伐他汀对比研究资料尚不充分。Meta分析显示,20 mg阿托伐他汀组IMT变化优于10mg组,MD=-0.21,95%CI[-0.25,-0.17];20 mg组LDL-C值低于10 mg组,MD=0.52,95%CI[0.44,0.61];2组不良反应未见明显差异。结论:阿托伐他汀用于预防脑卒中时,在IMT变化和降低LDL-C方面,阿托伐他汀20mg优于10mg,且在不良反应方面无明显差异。

Objective To analyze the influence of different doses of atorvastatin on carotid atherosclerosis and ischemic stroke in Chinese and to find safe and effective dose of atorvastatin to prevent ischemic stroke preferably for Chinese population.Methods PubMed,Medline,CNKI,VIP Chinese Science and Technology Journals were used to search randomized controlled trails（RCTs） about atovastatin on anti-atherosclerosis and stroke prevention from 1990 to 2011 by computer.The Meta-analysis evaluation software Revman 5.0 was applied,and some indicators were calculated by SPSS 13.0.The changes of intima-media thickness（IMT） and low density lipoprotein-cholesterol（LDL-C）,recurrence of ischemic stroke and side effects after treated with different doses of atorvastatin were compared with Meta-analysis.Results 10 and 20 mg atovastatin were widely used by Chinese.Comparative research on megadose atovastatin was still not fully enough.Meta-analysis showed that 20 mg atovastatin was more effective than 10 mg（P0.05） in the aspects of anti-atherosclerosis,and the change of IMT in 20 mg atovastatin group was better than 10 mg group,MD=-0.21,95%CI [-0.25,-0.17],and the LDL-C level in 20 mg group was lower than that in 10 mg group,MD=0.52,95%CI[0.44,0.61].At the same time there were no significant differences on adverse effects between two groups.Conclusion 20 mg atovastatin is more better than 10 mg on the changes of IMT,and reduction of LDL-C.There is no difference in adverse effects between 20 and 10 mg atovastatin.