他汀治疗慢性心力衰竭的meta分析

The effect of statin on chronic heart failure:a meta-analysis

目的:综合评估他汀对慢性心力衰竭(心衰)患者临床事件、心脏功能和炎症指标的作用。方法:以"heart failure、hydroxymethylglutaryl-CoA reductase inhibitors、randomized controlled trial"等为主题词联合关键词检索数据库PubMed、EMBASE和Cochrane library,应用Review Manager5.3软件和Stata13.0软件对纳入文献进行meta分析。结果:最终纳入21篇文献,meta分析显示:①他汀降低临床事件发生风险:因心衰住院风险[RR:0.84(0.70,0.99),P=0.04]和全因死亡风险(仅亲脂性他汀)[RR:0.58(0.41,0.82),P=0.002],但目前证据尚不足以证明他汀可降低心衰患者的心血管死亡风险[RR:0.97(0.90,1.04),P=0.37];②他汀改善心脏功能:提高左室射血分数(LVEF)[MD:2.89(1.37,4.41),P=0.000 2],减低B型利钠肽(BNP)[SMD:-0.26(-0.44,-0.07),P=0.006];③降低炎性因子水平:高敏C反应蛋白(hs-CRP)[SMD:-0.39(-0.58,-0.20),P<0.0001]和肿瘤坏死因子α(TNF-α)[SMD:-0.77(-1.07,-0.48),P<0.000 01]较对照组均降低;④亚组分析发现年龄<65岁、基础LVEF≥30%的心衰患者更易从他汀治疗中获益;相对于亲水性他汀,患者更易从亲脂性他汀治疗中获益。结论:他汀可使心衰患者临床获益,但患者年龄、基础LVEF水平及他汀类型等均可影响药物疗效。

Objective：To estimate the effects of statin on clinical events,cardiac function and cardiac inflammation in patients with chronic heart failure.Method：PubMed,EMBASE and Cochrane library were searched with MeSH keywords ＂heart failure＂, ＂hydroxymethylglutaryl-CoA reductase inhibitors＂ and ＂randomized controlled trial＂ combined with key words and date were analyzed by Review Manager 5.3and Stata 13.0.Result：A total of 21 publications were included.Meta-analysis results showed that：①Statin decreased the risk of hospitalization for worsening heart failure[RR：0.84（0.70,0.99）,P=0.04]as well as all-cause death[RR：0.58（0.41,0.82）,P=0.002]（lipophilic statin only）,but did not decrease cardiovascular death risk [RR：0.97（0.90,1.04）,P=0.37];②Statin improved left ventricular ejection（LVEF）[MD：2.89（1.37,4.41）,P=0.0002],and reduced the level of BNP[SMD：-0.26（-0.44,-0.07）,P=0.006];③Statin decreased the level of hs-CRP [SMD：-0.39（-0.58,-0.20）,P〈0.000 1]and TNF-α[SMD：0.77（-1.07,-0.48）,P〈0.000 01];④Further subgroup-analysis revealed that patients younger than 65-year old or with≥30% baseline LVEF benefitted more from statin and patients benefitted more from lipophilic statin than hydrophilic statin.Conclusion：Heart failure patients could benefit from statin.While the effect of statin is affected by the age,the baseline LVEF and the type of statin.