非心脏手术前加用他汀类药物干预治疗有效性的Meta分析

Meta analysis of perioperative statin therapy for improving outcomes during and after noncardiac surgery

目的：对非心脏手术前加用他汀治疗的有效性作出较客观评估。方法制订原始文献的纳入标准、排除标准及检索策略，检索Pubmed、EMBASE、Springer、The Cochrane Library数据库、中国期刊全文数据库、万方数据库及维普中文科技期刊数据库等，获得研究非心脏手术前加用他汀治疗的有效性的相关文献，对纳入研究进行筛选和评价后采用 Cochrane 协作网提供的 Rev Man 5.2统计学软件进行统计分析。结果共纳入5个有关非心脏手术前加用他汀治疗有效性的随机对照研究文献，非心脏手术前加用他汀治疗的RR 心源性死亡率＝0.51（95%CI 0.28～0.94），P＝0.03；RR 心肌梗死发生率=0.55（95%CI 0.35～0.88），P＝0.01。全因死亡率、卒中发生率、新发房颤发生率的数据分析无统计学意义。结论本研究在一定程度上反映了非心脏手术前应用他汀治疗可有效降低心源性死亡率、心肌梗死发生率，但由于纳入研究较少，质量不高，尚需开展和设计多中心大样本的随机对照试验做进一步验证。

Objective To evaluate the efficacy of short-term statin therapy commenced before noncardiac surgery. Methods The inclusion criteria and exclusion criteria of original literature and retrieval strategy were made strictly. The literatures about from the Pubmed, EMBASE, Springer, The Cochrane Library, Weipu and Wanfang database were searched.Taking into account the possibilities of heterogeneity of the studies, a statistical test for heterogeneity was performed.The Meta-analysis was applied with Rev Man 5.2. Results A total 5 clinical trials were discovered. Compared with control group, the total RR of death from cardiovascular of short-term statin therapy commenced before noncardiac surgery was 0.51（95%CI 0.28-0.94）, RR of the rate of myocardial infarction was 0.55（95%CI 0.35-0.88）, both showing significant difference（P〈0.05）; the rate of all-cause mortality, stroke and new atrial fibrillation showed no difference. Conclusions The exist researches show that the incidence of death from cardiovascular and myocardial infarction can be reduced after using with statin. But in view of the fact that the study is less, the quality is not high, so it is still need to develop and design a large sample randomized controlled trial for further verification.