冠状动脉旁路移植术后使用负荷剂量他汀类药物中长期疗效的Meta分析

Meta-analysis of medium- and long-term efficacy of loading statins after coronary artery bypass grafting surgery

目的对比评价行冠状动脉旁路移植（coronaryarterybypassgrafting，CABG）手术后使用负荷剂量他汀类药物或普通剂量他汀类药物，中长期治疗的效果。方法检索考克兰图书馆（Cochranelibrary）、万方数据库等数据库。筛选国内、外中、英文发表关于冠状动脉旁路移植术后使用负荷剂量他汀类药物疗效的临床随机对照试验（RCTs）。按照theNewcastle．OttawaScale（NOS）系统评价方法对纳入文献质量进行评价，治疗效果统计结果以加权均数差（WMD），比值比用（OR）和95％置信区间（CI）表示。使用Revman5．2软件进行数据处理分析。结果8篇文献纳入分析，总样本量8676例，使用负荷剂量他汀类药物组4352例，使用普通剂量他汀类药物组4324例。Meta分析结果显示，负荷剂量他汀组患者在行CABG术1～10年后，体内低密度脂蛋白（LDL—C）水平（WMD=-42．15，95％CI：-44．45--39．84，P〈0．00001）；心肌梗死死亡发生人数（OR=0．74，95％CI：0．60-0．91，P=0．005）；心肌梗死发生人数（OR=0．78，95％CI：0．66-0．92，P=0．004）；二次CABG手术发生人数（OR=0．72，95％CI：0．63-0．82，P〈0．00001）；药物不良反应发生人数（OR=1．43，95％CI：1．06—1．93，P=0．02）；血管内超声（IVUS）检查冠状动脉再狭窄发生人数（OR=0．59，95％CI：0．50～0．70，P〈0．0001）。以上数据差异均具有统计学意义。结论CABG术后使用负荷剂量他汀类药物可以显著降低患者体内LDL—C水平；可以降低心肌梗死死亡、心肌梗死、二次CABG手术等不良心脏事件发生；延缓旁路血管再狭窄发生。使用负荷剂量他汀类药物的药物不良反应较普通剂量他汀类药物稍高，但绝大多数患者长期服用负荷剂量他汀类药物后并未出现严重药物不良反应。总之，CABG术后使用负荷剂量他汀类药物的中长期疗效较普通剂量他汀类药物好。

Objective To evaluate the medium-and long-term efficacy of loading statins after coronary artery bypass grafting surgery by comparing patients undergoing coronary artery bypass grafting surgery（CABG） using a loading dose statins or a regular dose of statins. Methods Cochrane Library, WanFang database etc database web were searched for the efficacy of a loading dose of statins after CABG in randomized controlled trials （RCTs）. The quality of included studies was evaluated ac- cording to the Newcastle-Ottawa Scale（NOS）. The statistical results of treatment were represented by weighted mean difference （ WMD ）, the odds ratio （OR） and 95 % confidence intervals （CI）. Revman 5.2 software was used for data processing and a- nalysis. Results There are eight studies including 8 676 cases, 4 352 cases are in group using a loading dose of statins, 4 324 cases are in group using a regular dose of statins. Meta-analysis showed the level of low-density lipoprotein （LDL-C） in patients who took a loading dose of statins after CABG（WMD = - 42.15,95% CI： - 44.45- - 39.84, P 〈 0. 00001 ） ; the number of death caused by myocardial infarction（ OR = 0.74, 95 % CI： 0. 60- 0.91, P = 0. 005 ） ; the number of patients occurred myo-cardial infarction （ OR = 0. 78, 95 % CI：0. 66- 0.92, P = 0. 004） ; the number of patients undergoing secondary CA BG （ OR = 0. 72, 95 % CI： 0.63 -0.82, P 〈 0. 00001 ） ; the number of patients occurred drug side effects （ OR = 1.43, 95 % CI： 1.06 1.93, P = 0. 02 ） ; the number of patients occurred grafts restenosis by intravascular ultrasound （IVUS） （ OR = 0.59, 95 % CI： 0.50- 0.70, P 〈 0. 0001 ）. The data above reached statistically significant difference. Conclusion Comparing patients who used a loading dose of statins and those who used a regular dose of statins after CABG. The medium- and long-term efficacy of a loading dose of statins showed significantly reduction of LDL-C ; reduction of the occurrence to cardiac events, such as death caused by myocardial infarction, myocardial infarction and secondary CABG; reduction of grafts restenosis. The incidence of drug side effects was a little higher in a loading dose of statin group. But the majority of patients did not show serious drug side effects after using a loading dose of statins. In summary, the medium- and long-term efficacy of a loading dose of statins after CABG is better than that of a regular dose of statins.