LDL-C降脂治疗在非ST段抬高型急性冠脉综合征中对MACE事件影响的Meta分析

Efficacy of LDL-C lowering therapy in patients with non-ST-segment elevation acute coronary syndrome:a meta-analysis

目的系统评价LDL-C降脂治疗在非ST段抬高型急性冠脉综合征(NSTE-ACS)中的作用,为临床治疗选择合适的降脂目标。方法计算机检索Pub Med、EMbase、The Cochrane Central Register of Controlled Trials和Web of Science数据库,搜集LDL-C降脂治疗在非ST段抬高型急性冠脉综合征中对主要心血管事件(MACE)影响的随机对照试验(RCT),检索时限均为建库到2016年1月。由两位研究者独立筛选文献、提取资料和评价纳入RCT的偏倚风险后,采用Stata 12.0和Rev Man 5.3软件进行Meta分析。结果共纳入12个RCT,4 702名NSTE-ACS患者。Meta分析结果显示,与空白对照组相比,他汀组可明显降低MACE的发病风险[RR=0.68,95%CI(0.549,0.834),P=0.000];在70 mg/d L≤目标LDL-C水平<100 mg/d L(平均随访18.68个月)时,MACE发生风险比其他目标LDL-C水平组低;在70 mg/d L≤目标LDL-C水平<100 mg/d L组中,降脂水平比基线LDL-C水平下降20%~40%(中等程度降脂,平均随访28.99个月)时,MACE发生风险最低[RR=20.143,95%CI(6.946,58.414),P=0.000]。结论 NSTE-ACS患者进行降脂治疗可明显降低MACE发生风险。当NSTEACS患者目标LDL-C水平在≥70 mg/d L,且<100 mg/d L时,可实现相对低的MACE发生风险,在此基础上相对于基线LDL-C水平下降20%~40%的人群,获益更明显。

Objective To investigate the efficacy of LDL-C lowering treatment on NSTE-ACS, and to analyze the target LDL-C level for clinical treatment. Methods PubMed, EMbase, the Cochrane Central Register of Controlled Trials, Web of Science databases were searched up to January 2016 for randomized controlled trials assessing the effects of LDL-C lowering therapy on major adverse cardiac events （MACE） in patients with NSTE-ACS. Two reviewers independently screened litertures, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using Stata12.0 and RevMan 5.3 software. Result A total of 12 RCT including 4 702 individuals with NATE-ACS were included. The results of meta-analysis showed that, compared with the control group, the statin group could significantly reduced the risk of MACE （RR=0.68, 95% CI 0.549 to 0.834, P=0.000）. With 18.68 months of follow-up, patients in target LDL-C level from over 70 mg/dL to less than 100 mg/dL group had lower risk of MACE than other LDL-C level group. When LDL-C lower 20% to 40% than baseline with 28.99 months follow-up, patients in target of LDL-C level from over 70 mg/dL to less than 100 mg/dL group had lowest risk of MACE （RR=20.143, 95% CI 6.946 to 58.414, P=0.000）. Conclusion LDL-C lower treatment can lower the risk of MACE in patients with NSTE-ACS. Patients in target LDL-C level from over 70 mg/dL to less than 100 mg/dL group have relatively low risk of MACE, in which patients who lower 20% to 40% LDL-C than baseline will get more benefits from LDL-C lowering therapy.