经皮冠状动脉介入治疗前应用他汀类药物患者围手术期心肌损伤的meta分析  

Effects of statins on periprocedural myocardial injury before percutaneous coronary intervention:a meta-analysis

作　　者：李汭傧[1] 崔炜[1] 耿雪[1] 

机构地区：[1]河北医科大学第二医院 河北省心脑血管病研究所心内科,河北石家庄050000

出　　处：《临床荟萃》2014年第2期125-133,共9页Clinical Focus

摘　　要：目的 客观评价经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）前他汀类药物治疗对围手术期心肌梗死、术后肌酸激酶同工酶（creatine kinase-MB,CK-MB）和肌钙蛋白（troponin）升高的影响.方法 检索PUBMED、EMCC、Highwire数据库及Cochrane图书馆等数据库.检索策略为：（percutaneous coronary intervention,OR PCI） AND （statin OR statins OR hydroxymethylglutaryl-CoA） AND （randomized trial）.入选试验满足条件：随机对照试验,PCI术前应用他汀类药物,试验组为服用他汀类药物的患者,对照组为服用安慰剂、未服用他汀类药物或者服用非大剂量他汀类药物的患者,以围手术期心肌梗死或者CK-MB、肌钙蛋白升高发生率为研究结局.采用比值比（OR）和95%可信区间（CI） 作为结果分析的统计量.应用RevMan 5.0以及SAS 9.2软件进行统计分析.结果 ①术前应用他汀类药物与未应用他汀类药物对比：与未应用他汀类药物比较,PCI术前应用他汀类药物治疗可以降低围手术期心肌梗死的发生率（OR=0.44,95%CI=0.34~0.57,P＜0.01）,术后CK-MB升高的发生率（OR=0.50,95%CI=0.40~0.62,P＜0.01）以及肌钙蛋白升高的发生率（OR=0.65,95%CI=0.49~0.86,P〈0.01）.进一步分析发现：只有PCI术前应用大剂量他汀类药物才可以减少围手术期心肌梗死（OR=0.41,95%CI=0.30~0.55,P＜0.01）,术后CK-MB升高（OR=0.43,95%CI=0.33~0.56,P＜0.01）以及肌钙蛋白升高的发生率（OR=0.57,95%CI=0.46~0.70,P＜0.01）;而非大剂量他汀类药物不能降低围手术期心肌梗死（OR=0.58,95%CI=0.34~0.99,P=0.05）、术后CK-MB升高（OR=0.75,95%CI=0.49~1.14,P〉0.05）以及肌钙蛋白升高的发生率（OR=0.91,95%CI=0.66~1.26,P〉0.05）.②术前应用大剂量他汀类药物与应用非大剂量他汀类药物对比：与应用非大剂量他汀类药物对比,PCI术前应用大剂量他汀可以降低围手术期心肌梗死的发生率（OR=0.40,95%CI=0.20~0.79,P〈0.01）,Objective This meta-analysis was to determine whether statins administration before percutaneous coronary intervention（PCI） can reduce the incidence of periprocedural myocardial infarction, creatine kinase-MB（CK- MB） and troponin elevation after PCI. Methods We searched PUBMED, EMCC, Highwire,Cochrane Library, and the search strategy was or PCI AND （statin or statins or hydroxymethylglutaryl-CoA） and （randomized trial）. The included studies must be randomized controlled trials and they must have a statin therapy group and a placebo or no statin or non-high dose statin control group, the endpoint should be the incidence of periprocedura i myocardial infarction or CK-MB and troponin elevation. Odds Ratios （ OR ） and 95o/oo CI were used to evaluate the effects of statins before PCI on periprocedural myocardial injury. Results @Compared to no statin, statins therapy before PCI reduced the incidence of periprocedural myocardial infarction （ OR = 0.44, 95% CI = 0.34-0.57, P 〈 0.01 ）, CK-MB and troponin elevation after PCI （CK-MB： OR =0.50,95% CI =0.40-0.62, P 〈0.01;troponin.. OR =0.65.95% CI =0.49- 0.86, P d0.01）. And subgroup analysis showed that only high-dose statins pretreatment reduced the incidence of periprocedural myocardial infarction （ OR = 0.41,95 % CI = 0.30-0.55, P 〈 0.01）, CK-MB and troponin elevation after PCI （CK-MB： OR =0.43,95% CI 0.33-0.56, P 〈0.01;troponin： OR =0.57.95%6I =0.46-0.70, P〈 0.01）. But non-high dose statins before PCI did not reduce the incidence of periprocedural myocardial infarction （ OR = 0.58,95% CI =0.34 0.99, P =0.05） ,CK-MB and troponin elevation after PCI （CK-MB.. OR =0.75,95% CI =0.49 1.14, P =0.18;troponin： OR =0.91,95% CI =0.66-1.26, P =0.58）. （Compared to non-high-dose statins,high dose statins pretreatment reduced the incidence of periprocedural myocardial infarction （ OR =0. 42,95 % CI = 0. 20- 0.79, P〈0.01）,CK MB and troponin elevation after PCI （CK-MB： OR = 0. 46, 95 Yoo CI =0.27 0.76, P 〈0.01）

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 心肌再灌注损伤 他汀 羟甲基戊二酰基COA还原酶抑制剂 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]