他汀类药物对感染患者预后影响的系统评价  

Effects of statins on mortality in patients with infection： a systematic review

作　　者：陆晓旻[1] 郭凤梅[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院危重病症学科东南大学临床医学院,南京210009

出　　处：《中华医学杂志》2011年第27期1875-1878,共4页National Medical Journal of China

摘　　要：目的评价他汀类药物对感染患者预后的影响。方法计算机检索和手工检索全面收集2000至2010年感染患者服用他汀类药物的相关研究，按纳入与排除标准选择文献，提取资料，按Cochrane协作网推荐的方法对数据进行系统评价分析。结果纳入16篇文献（回顾性队列研究11篇，前瞻性队列研究5篇），共包括治疗组8775例，对照组46539例患者。结果显示，治疗组和对照组病死率分别为5．2％（458／8775）和18．6％（8637／46539），与对照组比较，他汀类药物显著降低感染患者病死率[OR=0．51，（95％CI：0．36～0．71）；P〈0．00001]。5项前瞻性队列研究观察了他汀类药物对6774例感染患者病死率的影响，结果表明他汀类药物能降低病死率[OR=0．48，（95％CI：0．24～0．94）；P=0．03]，与回顾性研究结果一致[OR=0．66，（95％CI：0．58—0．75）；P=0．002]；大样本研究结果也提示他汀类药物对感染患者具有保护作用[OR=0．56，（95％CI：0．50～0．63）；P=0．02]。并且，他汀类药物能降低感染患者短期病死率[OR=0．47，（95％CI：0．29～0．78）；P=0．004]，但对ICU重症感染患者的病死率无明显影响[OR=0．69，（95％CI：0．32～1．48）；P=0．34]。结论他汀类药物可以改善感染患者的预后，但不能明显改善危重症患者的重症感染病死率。目前缺乏高质量的研究，尚需大样本随机对照试验证实。Objective To review systematically the literatures regarding the effect of statins on mortality in patients with infection. Methods PUBMED, EMBASE, Web of Science and CNKI databases from 2000 to 2010 were searched. And the clinical trials on statins-related mortality in patients with infection were identified by electronic and manual searching. A systematic review of relevant data was conducted by the methods as recommended by the Cochrane Collaboration. Results Sixteen trials （ 11 retrospective and 5 prospective cohort studies） involving 8775 cases in statins group and 46 539 in control group were included for analysis. The mortalities of infection were 5.2% （458/8775） and 18. 6% （8637/46 539） in statins and control groups respectively. In comparison with control group, statins could reduce the mortality in patients with infection [ OR =0. 51, （95% CI：0. 36 - 0. 71 ） ; P 〈 0. 000 01 ]. Prospective cohort studies observed 6774 patients with infection whose survival were improved by statins [ OR = 0. 48, （95% CI：0. 24 -0. 94） ; P =0. 03]. It was consistent with the results of retrospective cohort studies [ OR =0. 66, （95% CI：0. 58 - 0.75） ; P=0.002] and large sample studies [OR =0.56, （95% CI：0. 50 -0.63） ; P =0.02]. Statins lowered the short-term mortality [ OR = 0.47, （95% CI：0. 29 - 0.78 ） ; P = 0. 004 ], but failed to improve the outcomes of severe septic patients in Intensive Care Unit （ICU） [ OR = 0. 69, （95% CI：0. 32 -1.48 ） ; P = 0. 34 ]. Conclusion Statins have favorable effects on the patients with infection, but there is no effect for severe septic patients in ICU. Further randomized controlled trials of a large sample size are warranted.

关 键 词：西司他汀类 感染 预后 评价研究 

分 类 号：R459.7[医药卫生—急诊医学]