阿托伐他汀钙治疗颈动脉斑块的系统评价

Atorvastatin Calcium for Treatment of Carotid Plaques: A Systematic Review

目的:系统评价阿托伐他汀钙治疗颈动脉斑块的临床疗效和不良反应,为临床合理用药提供依据。方法:计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库(WanFang Date),纳入阿托伐他汀钙治疗颈动脉斑块的随机对照试验(RCT),检索时限均为1997年至2013年3月,按照Cochrane系统评价方法筛选文献、提取资料和评价纳入文献质量,并以RevMan5.0分析软件进行Meta分析。结果:最终纳入9个RCT,共1 055例患者。Meta分析结果显示:(1)颈动脉内膜-中膜厚度(IMT):纳入7个研究,与对照组相比,阿托伐他汀钙能显著减少IMT(MD=-0.31,95%Cl=-0.52～-0.11,P=0.003);(2)斑块面积:纳入4个研究,阿托伐他汀钙能显著减少斑块面积(MD=-5.22,95%Cl=-11.17～0.74,P=0.09);(3)对C反应蛋白(CRP)的影响:纳入4个研究,阿托伐他汀钙能显著降低CRP水平(MD=-2.38,95%Cl=-5.04～0.28,P=0.08);(4)斑块积分:纳入4个研究,阿托伐他汀钙能更好的减小颈动脉斑块积分,有明显疗效(MD=-0.43,95%Cl=-1.82～0.97,P=0.55);(5)不良反应:纳入4个研究,阿托伐他汀钙不良反应轻(MD=4.77,95%Cl=1.02～22.37,P=0.05)。结论:阿托伐汀钙能显著减少颈动脉斑块面积的大小、IMT,降低CRP、血脂等,用来防治颈动脉斑块发生与发展,可显著降低卒中发生率。

OBJECTIVE： To evaluate the efficacy and adverse reactions of atorvastatin calcium in the treatment of carotid artery plaques so as to provide references for clinical rational use of drugs. METHODS： The randomized controlled trials （RCTs） about atorvastatin calcium for treatment of carotid plaques from 1997 to March 2013 were retrieved from databases including CNKI, CBM, WanFang Database. The screening of RCTs, data extraction and quality evaluation of the included RCTs were performed according to the Cochrane system and the meta-analyses were performed with Rev Man5.0 software. RESULTS： Nine randomized trials involving 1 055 patients were included. The results of meta-analyses showed the following： 1 ） carotid intima-media thickness （IMT） ： In 7 RCTs included as compared with control group, atorvastatin calcium were noted to be associated with a significant reduction of carotid intima-media thickness （IMT） [MD ~ -0, 31,95% Cl （ -0. 52, -0. 11 ）, P =0. 003 ] ; 2） plaque area： In 4 RCTs included as compared with control group, atorvastatin calcium significantly reduced the area of plaque [ MD = - 5.22, 95% Cl （ - 11.17, 0.74）, P ~ 0, 09~] ~ 3 ） Impact of atorvastatin calcium on C-reactive protein： In 4 RCTs included as compared with control group, atorvastatin calcium significantly reduced C-reactive protein compared to the control group [ MD = - 2. 38, 95% Cl （ - 5.04,0.28 ）, P = 0. 08 ] ; 4 ） carotid plaque integral ： In 4 RCTs included as compared with control group, atorvastatin calcium showed better curative efficacy in reducing carotid plaque integral [ MD = - 0.43, 9~% Cl （ - 1.82, 0. 97）, P = 0.55 ] ; 5 ） Adverse effects ： In 4 RCTs included as compared with control group, atorvastatin calcium ahow^d mild adverse drug reactions [ MD = 4.77, 95% Cl （ 1.02, 22.37 ）, P = 0. 05 ]. CONCLUSION ： Atorvastatin calcium significantly reduced the area of carotid plaques, the film thickness in the carotid artery, CRP levels and blood lipid level etc, and it has remarkable curative efficacy in the Prevention nfoccurrence and development and treatment of carotid artery plaque and in the reduction of the incidence of cerebral apoplexy.