他汀类药物对社区获得性肺炎治疗作用及患病风险的Meta分析

Role of Statins in Treatment and Prevention of Community-acquired Pneumonia:A Meta-analysis

目的系统评价他汀类药物对社区获得性肺炎(CAP)预后及CAP患病风险的影响。方法计算机检索Pub Med、EMbase、万方医学网及中国知网,检索时间限定为自建库至2016年10月。纳入符合标准的文献21篇,根据Cochrane系统评价手册5.0或Newcastle-Ottawa Scale(NOS)质量评价标准评价纳入研究质量。由两名研究员独立进行文献筛选、资料提取和质量评估,采用Rev Man5.3软件进行Meta分析。结果纳入12篇文献共1 007 765例CAP患者,其中CAP发病前后使用他汀类药物118 096例,未使用他汀类药物889 669例;Meta分析结果显示,他汀类药物的使用能显著降低CAP患者的病死率(OR=0.67,95%CI:0.57~0.79);将上述文献按患者人群分为美洲和欧洲进行亚组分析,前者文献间异质性较小,后者文献间异质性较大,两个亚组分析结果均显示使用他汀类药物能显著降低CAP患者的病死率(OR=0.66,95%CI:0.62~0.67;OR=0.71,95%CI:0.55~0.92)。关于是否降低CAP患者的机械通气率共纳入3篇文献共123 645例CAP患者,其中CAP发病前后使用他汀类药物23 796例,不使用他汀类药物99 849例;Meta分析结果显示,发病前后使用他汀类药物能显著降低CAP患者的机械通气率(OR=0.74,95%CI:0.70~0.78)。关于是否会降低CAP患者的ICU入住率共纳入4篇文献共127 060例CAP患者,其中CAP发病前后使用他汀类药物24 121例,不使用他汀类药物102 939例;Meta分析结果显示,发病前后使用他汀类药物能显著降低CAP患者的ICU入住率(OR=0.85,95%CI:0.82~0.88)。关于是否会降低CAP患者的患病风险共纳入11篇文献共2 124 849例CAP患者,其中CAP发病前长期使用他汀类药物306 108例,不使用他汀类药物1 818 741例;Meta分析结果显示,使用他汀类药物不能显著降低CAP的患病风险(OR=0.85,95%CI:0.85~1.07);将上述文献按病例对照研究和队列研究进行亚组分析,前者显示他汀类可显著增加CAP患病风险(OR=1.12,95%CI:1.03~1.21),后者显示他汀类可显著降低CAP患病风险(OR=0.46,95%CI:0.44~0.49)。结论发病前后使用他汀类药物能显著降低CAP患者的病死率、机械通气率及ICU入住率。长期使用他汀类药物是否可降低CAP的患病风险尚不明确。

Objective To systemically evaluate the the role of statins in prevention and treatment of community-acquired pneumonia(CAP).Methods A computer-based searching was conducted in Pub Med,EMbase,Cochrane Library,Wanfang,and CNKI database up to October 2016.Totally 21 eligible articles were retrieved.According to the Cochrane Handbook 5.0 or Newcastle-Ottawa Scale(NOS) quality evaluation criteria,two independent reviewers carried out literature screening,data retraction,and quality evaluation.Meta-a-nalysis was conducted with Rev Man 5.3 software.Results A total 1 007 765 CAP patients from 12 studies were divided into two groups:statin group(n=118 096) and non-statin group(n=889 669).Meta-analysis suggested that statin use was associated with decreased mortality of CAP(OR=0.67,95% CI:0.57-0.79).We further divided the studies into North America group and Europe group and found the heterogenicity of North America group was lower than that of Europe group,and the Meta-analysis of both group supported the association of statin use with decreased CAP mortality(OR=0.66,95% CI:0.62-0.67;OR=0.71,95% CI:0.55-0.92).To identify the effect of statin use on mechanical ventilation,we included three articles(n=123 645)for further analysis(statin group,n=23 796;non-statin group,n=99 849),and Meta-analysis suggested that statin use was associated with decreased requirement for mechanical ventilation(OR=0.74,95% CI:0.70-0.78).Four articles(n=127 060) were enrolled(statin group,n=24 121 and non-statin group,n=102 939) to analyze the effect of statin use on ICU admission,and Meta-analysis suggested that statin use was associated with decreased requirement for ICU admission(OR=0.85,95% CI:0.82-0.88).Eleven articles(n=2 124 849)(statin group,n=306 108;non-statin group,n=1 818 741) to evaluate the effect of statin use on risk of CAP,and Meta-analysis suggested that long-term use of statins decreased the risk of CAP,although there was no statistical difference(OR=0.85,95% CI:0.85-1.07);the above studies were divided into case-control studies and cohort studies,and the case-control studies revealed statins increased the risk of CAP(OR=1.12,95% CI:1.03-1.21),while the cohort studies supported the association of statin use with decreased CAP risk(OR=0.46,95% CI:0.44-0.49).Conclusions Statin use may decrease the CAP mortality and the requirement for mechanical ventilation or ICU admission.However,whether statin use can reduce the risk of pneumonia remains unclear.