大剂量阿托伐他汀用于中国冠心病患者抗炎治疗有效性及安全性的Meta分析

Meta analysis of the efficacy and safety of high-dose atorvastatin in anti-inflammatory treatment of Chinese patients with coronary heart disease

目的 系统评价大剂量阿托伐他汀药物用于中国冠心病患者抗炎治疗的有效性及安全性。方法 检索自建库年至2019年12月PubMed、CNKI、VIP、CBM、万方等数据库公开发表的以大剂量和常规剂量的阿托伐他汀治疗冠心病的随机对照试验,提取资料后采用RevMan 5.3统计学软件进行Meta分析。结果 共纳入12篇中文RCT,包括1 191例患者。Meta分析显示,与常规剂量阿托伐他汀相比较,大剂量阿托伐他汀治疗能显著降低CRP(SMD=0.75,95%CI:0.34~1.16,P<0.05)、IL-6(SMD=0.99,95%CI:0.42~1.56,P<0.05)及TNF-α(SMD=0.71,95%CI:0.51~0.91,P<0.05)血清浓度,但不良反应增加(RR=2.07,95%CI:1.31~3.26,P<0.05)。结论 相较于常规剂量,大剂量阿托伐他汀更能降低血清炎性因子水平,改善冠心病患者的预后,但可能增加不良反应发生风险,临床工作中需对收益和风险进行慎重评估。

Objective To systematically evaluate the efficacy and safety of high-dose atorvastatin in anti-inflammatory treatment of Chinese patients with coronary heart disease.Methods The randomized controlled trials of high-dose and conventional dose atorvastatin in the treatment of coronary heart disease published in PubMed, CNKI, VIP, CBM, WanFang and other databases from the year of database establishment to December 2019 were retrieved. The data were extracted and meta-analysis was performed by RevMan 5. 3 statistical software.Results A total of 12 Chinese RCTs were included,including 1 191 patients. Meta analysis showed that compared with conventional dose atorvastatin, high-dose atorvastatin treatment could significantly reduce the serum concentrations of CRP(SMD = 0. 75, 95%CI:0. 34 ~ 1. 16,P< 0. 05), IL-6(SMD =0. 99, 95%CI:0. 42 ~1. 56,P<0. 05) and TNF-α(SMD = 0. 71, 95%CI:0. 51 ~ 0. 91,P< 0. 05), but the adverse reactions increased(RR=2. 07, 95%CI:1. 31 ~ 3. 26,P< 0. 05).Conclusion Compared with conventional dose, high-dose atorvastatin can reduce the level of serum inflammatory factors and improve the prognosis of patients with coronary heart disease,but it may increase the risk of adverse reactions. It is necessary to carefully evaluate the benefits and risks in clinical work.