他汀治疗慢性心力衰竭的meta分析

贾晨平; 唐婷婷; 夏霓; 程翔

doi:10.13201/j.issn.1001-1439.2016.12.016

他汀治疗慢性心力衰竭的meta分析

- 1 华中科技大学附属协和医院心内科(武汉, 430032);
- 2 济宁市第一人民医院心内科

详细信息

通讯作者: 程翔,E-mail:nathancx@mail.hust.edu.cn

中图分类号: R541.6

收稿日期: 2016-05-19

修回日期: 2016-09-22

The effect of statin on chronic heart failure:a meta-analysis

- 1 Department of Cardiology, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China;
- 2 Department of Cardiology, Jining No.1 People's Hospital

More Information

Corresponding author: CHENG Xiang, E-mail: nathancx@mail.hust.edu.cn

Received Date: 19 May 2016

Revised Date: 22 September 2016

摘要

摘要: 目的:综合评估他汀对慢性心力衰竭(心衰)患者临床事件、心脏功能和炎症指标的作用。方法:以"heart failure、hydroxymethylglutaryl-CoA reductase inhibitors、randomized controlled trial"等为主题词联合关键词检索数据库PubMed、EMBASE和Cochrane library,应用Review Manager5.3软件和Stata13.0软件对纳入文献进行meta分析。结果:最终纳入21篇文献,meta分析显示:①他汀降低临床事件发生风险:因心衰住院风险[RR:0.84(0.70,0.99),P=0.04]和全因死亡风险(仅亲脂性他汀)[RR:0.58(0.41,0.82),P=0.002],但目前证据尚不足以证明他汀可降低心衰患者的心血管死亡风险[RR:0.97(0.90,1.04),P=0.37];②他汀改善心脏功能:提高左室射血分数(LVEF)[MD:2.89(1.37,4.41),P=0.000 2],减低B型利钠肽(BNP)[SMD:-0.26(-0.44,-0.07),P=0.006];③降低炎性因子水平:高敏C反应蛋白(hs-CRP)[SMD:-0.39(-0.58,-0.20),P<0.0001]和肿瘤坏死因子α(TNF-α)[SMD:-0.77(-1.07,-0.48),P<0.000 01]较对照组均降低;④亚组分析发现年龄<65岁、基础LVEF≥30%的心衰患者更易从他汀治疗中获益;相对于亲水性他汀,患者更易从亲脂性他汀治疗中获益。结论:他汀可使心衰患者临床获益,但患者年龄、基础LVEF水平及他汀类型等均可影响药物疗效。
- 心力衰竭 /
- 他汀 /
- meta分析
Abstract: Objective: To estimate the effects of statin on clinical events, cardiac function and cardiac inflammation in patients with chronic heart failure. Method: PubMed, EMBASE and Cochrane library were searched with MeSH keywords"heart failure", "hydroxymethylglutaryl-CoA reductase inhibitors" and "randomized controlled trial" combined with key words and date were analyzed by Review Manager 5.3 and Stata 13.0. Result: A total of 21 publications were included. Meta-analysis results showed that:①Statin decreased the risk of hospitalization for worsening heart failure [RR: 0.84 (0.70,0.99), P=0.04] as well as all-cause death [RR:0.58(0.41,0.82), P=0.002] (lipophilic statin only), but did not decrease cardiovascular death risk [RR:0.97(0.90,1.04), P=0.37]; ②Statin improved left ventricular ejection (LVEF) [MD: 2.89(1.37, 4.41), P=0.0002], and reduced the level of BNP [SMD:-0.26(-0.44, -0.07),P=0.006]; ③Statin decreased the level of hs-CRP [SMD:-0.39(-0.58, -0.20), P<0.000 1] and TNF-α [SMD: 0.77(-1.07,-0.48),P<0.000 01]; ④Further subgroup-analysis revealed that patients younger than 65-year old or with ≥30% baseline LVEF benefitted more from statin and patients benefitted more from lipophilic statin than hydrophilic statin.Conclusion: Heart failure patients could benefit from statin. While the effect of statin is affected by the age, the baseline LVEF and the type of statin.
- heart failure /
- statin /
- meta-analysis

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