阿托伐他汀对稳定期COPD患者肺功能、肺动脉压及相关指标影响的Meta分析

Effects of Atorvastatin on Pulmonary Function,Pulmonary Arterial Pressure and Related Indexes in Stable COPD Patients:A Meta-analysis

目的:系统评价阿托伐他汀对稳定期慢性阻塞性肺疾病(COPD)患者肺功能、肺动脉压及相关指标的影响,为临床提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、EMBase、中国期刊全文数据库、中文科技期刊数据库,收集阿托伐他汀联合常规基础方案(试验组)对比单纯常规基础方案(对照组)治疗稳定期COPD的随机对照试验(RCT),提取资料并按照Cochrane系统评价员手册5.1.0评价质量后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入7项RCT,合计371例患者。Meta分析结果显示,试验组患者第1秒用力呼气容积[MD=0.07,95%CI(0.04,0.09),P<0.001]、第1秒用力呼气容积占预计值百分比[MD=6.18,95%CI(2.23,10.12),P=0.002]、6分钟步行距离[MD=55.31,95%CI(36.44,74.18),P<0.001]均显著高于/长于对照组,肺动脉收缩压[MD=-6.78,95%CI(-11.62,-1.94),P=0.006]、平均肺动脉压[MD=-6.61,95%CI(-7.26,-5.96),P<0.001]、圣乔治呼吸问卷评分[MD=-13.21,95%CI(-23.90,-2.52),P=0.02]均显著低于对照组,差异均有统计学意义;两组患者第1秒用力呼气容积占用力肺活量比值[MD=3.73,95%CI(-2.08,9.55),P=0.21]和高敏C反应蛋白水平[MD=0.29,95%CI(-1.37,1.95),P=0.73]比较,差异均无统计学意义。结论:阿托伐他汀用于稳定期COPD患者可以显著改善患者肺功能和肺动脉压,提高患者生活质量。

OBJECTIVE ： To systematically evaluate the effects of atorvastatin on pulmonary function, pulmonary arterial pressure and related indexes in patients with stable chronic obstructive pulmonary disease （COPD）, and to provide evidence-based refer- ence. METHODS： Retrieved from Cochrane Library, PubMed, EMBase, CJFD and VIP, randomized controlled trials （RCTs）about atorvastatin combined with conventional therapy （trial group） vs. conventional therapy alone （control group） in the treatment of sta- ble COPD were collected. Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation by Cochrane Handbook Manual 5.1.0. RESULTS： Totally 7 RCTs were included, involving 371 patients. Results of Meta-analysis showed, FEV1 [MD=0.07, 95% CI （0.04, 0.09）, P〈0.001], FEV1% pred [MD=-6.18 , 95% CI （2.23, 10.12）, P=0.002] and 6MWD [MD=- 55.31,95 % CI （36.44,74.18）, P〈 0.001] of trial group were significantly higher/longer than those of control group; pulmonary artery systolic pressure [MD=- 6.78, 95 % CI （ - 11.62, - 1.94）, P= 0.006], mean pulmonary artery pres- sure [MD=-6.61,95%CI（-7.26,-5.96）,P〈0.001], St. George respiratory questionnaire [MD=-13.21, 95%CI（--23.90,-2.52）, P=0.02] were significantly lower than control group, with statistical significance. There was no statistical difference in FEV1/FVC [MD=-3.73,95%CI（-2.08,9.55） ,P=0.21] or hs-CRP [MD=-0.29, 95%CI（ - 1.37, 1.95） ,P=0.73] between 2 groups. CONCLU- SIONS： Atorvastatin can significantly improve pulmonary function and pulmonary arterial pressure in patients with stable COPD, and can improve the quality of life.