阿托伐他汀治疗扩张型心肌病伴慢性充血性心力衰竭患者疗效的Meta分析  

Atorvastatin for Dilated Cardiomyopathy Complicating Chronic Heart Failure:A Meta-Analysis

作　　者：孔祥勇[1] 胡世莲[1] 沈干[2] 吴蕾[3] 徐维平[4] 陈尹[5] 徐婷娟[5] 

机构地区：[1]安徽省立医院心血管内科老年医学科,合肥230001 [2]安徽省委机关医院干部病房,合肥230001 [3]安徽省立医院神经内科,合肥230001 [4]安徽省立医院药剂科,合肥230001 [5]安徽省循证医学中心,合肥230001

出　　处：《中国循证医学杂志》2012年第10期1223-1228,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价阿托伐他汀治疗扩张型心肌病(DCM)伴慢性充血性心力衰竭(CHF)患者的疗效与安全性。方法计算机检索PubMed、Cochrane图书馆、EMbase、CNKI、CBM、VIP等数据库,收集阿托伐他汀治疗扩张型心肌病伴慢性充血性心力衰竭的随机对照试验,检索时限均从建库至2011年10月。严格按照纳入标准筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入11个研究,包括648例患者。Meta分析结果显示,治疗约6个月后,与对照组比较,阿托伐他汀组的左室射血分数和6分钟步行距离明显增加[MD=3.92,95%CI(1.93,5.92),P=0.000 1;MD=17.92,95%CI(0.36,35.47),P=0.05],外周血CRP水平明显降低[MD=–1.91,95%CI(–3.03,–0.79),P=0.000 9]。结论当前证据表明,扩张型心肌病伴慢性充血性心力衰竭患者在常规抗心衰治疗基础上加用阿托伐他汀可在一定程度上改善心功能,增加左室射血分数,降低炎性标志物水平。因此,阿托伐他汀很可能成为治疗扩心所致非缺血性心衰的又一安全有效的药物,但上述结论尚需更多大样本高质量临床试验加以验证。Objective To systematically assess the effectiveness and safety of atorvastatin in patients with dilated cardiomyopathy （DCM） complicating chronic heart failure （CHF）. Methods Databases including PubMed, The Cochrane Library, EMbase, CNKI, CBM, and VIP were searched from inception to November 2011 to collect randomized controlled trials （RCTs） on atorvastatin for DCM accompanied with CHF. According to the inclusion criterion, relevant articles were screened, Then we extracted data, assessed quality, and performed meta-analysis using RevMan 5.0. Results A total of 11 RCTs involving 648 patients were included. The result of meta-analyses showed that compared with the control group at the sixth month after treatment, in the atorvastatin group, left ventricular ejection fraction （LVEF） obviously （MD=3.92, 95%CI 1.93 to 5.92, P=0.000 1） and 6-minute walk distance （MD=13.15, 95%CI 5.47 to 20.83, P=0.000 8） increased. Besides, serum level of CRP obviously decreased in the atorvastatin group （MD=I.91, 95%CI 3.03 to 0.79, P=0.O00 9）. Conclusion Current evidence indicates that atorvastatin, based on routine treatment, can improve cardiac function to some extent, increase LVEF, and reduce serum levels of inflammatory markers for patients with DCM complicating CHF. Therefore, atorvastatin is likely to be a safe and effective drug for non-ischemic cardiomyopathy due to DCM, which still has to be proved by more large-scale and high-quality clinical trials.

关 键 词：扩张型心肌病 阿托伐他汀 心力衰竭 META分析 系统评价 随机对照试验 

分 类 号：R542.2[医药卫生—心血管疾病] R541.6[医药卫生—内科学]