阿昔莫司联合他汀治疗高脂血症的系统评价与Meta分析

Systematic evaluation and meta-analysis of acipimos co-administrated with statin in hyperlipemia treatment

目的通过对目前已发表的随机对照及半随机对照试验进行系统评价与Meta分析,评价阿昔莫司联合他汀治疗高脂血症的疗效与安全性。方法计算机检索Pub Med、EMbase、Cochrane Central Register of Controlled Trials、CNKI、万方和维普数据库,检索时间均为建库至2015年2月,检索Clinical Trials获得已注册但未发表的研究,手工检索相关杂志以及纳入文献的参考文献,两个作者独立阅读所有文献,按入选标准纳入试验、提取资料和质量评价后,采用Rev Man 5.1软件进行Meta分析。结果共纳入19项研究,包括1895例患者。Meta分析显示,与单独应用他汀相比,阿昔莫司联合他汀可降低高脂血症患者总胆固醇(TC)(SMD=-0.57,95%CI:-0.98^-0.17],P<0.00001)、低密度脂蛋白胆固醇(LDL-C)(SMD=-1.33,95%CI:-2.01^-0.65,P<0.00001)、三酰甘油(TG)(SMD=-1.74,95%CI:-2.31^-1.16,P<0.00001),升高高密度脂蛋白胆固醇(HDL-C)(SMD=1.74,95%CI:1.14~2.34,P<0.00001)。阿昔莫司联合他汀治疗高脂血症与单独应用他汀相比,不良反应发生率更高(OR=1.55,95%CI:1.09~2.21,P=0.002)。结论阿昔莫司联合他汀能够得到比单用他汀更强的降脂疗效,但不良反应也会增加。

Objective To evaluate the efficacy and safety of acipimos co-administrated with statin in hyperlipemia treatment by systematically evaluated and meta-analyze published studies of randomized controlled trials and quasi-randomized control trials. Methods Databases including PubMed, EMbase, Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP Database and Clinical Trials were searched electrically to collect literatures published from database foundation to Feb 2015. The relevant periodicals and references of the included studies were manually retrieved. Two reviewers independently screened and determined the eligibility of study, extracted data and assessed the quality of each included study. The meta-analysis was conducted using RevMan 5.1 software. Results A total of 19 studies involving 1895 patients were included. The results of metaanalysis showed that, compared with statin monotherapy, acipimos co-administrated with statin was associated with a statistically significant in Total cholesterol lipoprotein (SMD=-0.57, 95%CI: -0.98^-0.17, P<0.00001),low-density lipoprotein cholesterol (SMD=-1.33,95%CI: -2.01^-0.65, P<0.00001), triglyceride (SMD=-1.74,95%CI: -2.31^-1.16, P<0.00001), and high-density lipoprotein cholesterol (SMD=1.74, 95%CI: 1.14~2.34, P<0.00001). Adverse reactions were higher when using acipimos co-administrated with statin than using statin monotherapy (OR=1.55, 95%CI: 1.09~2.21, P=0.002). Conclusion Acipimos combined with statin has better effects in reducing the lipid level compared with statin monotherapy, with higher adverse reactions rate.