长期使用他汀类药物降低COPD患者死亡风险及肺动脉压的Meta分析  

Meta-analysis of Long-term Use of Statins to Reduce Mortality and Pulmonary Hypertension in Patients with COPD

作　　者：何芳[1] 刘美成 秦勤[1] He Fang;Liu Meieheng;Qin Qin(Department of Respiratory Medicine,West China Hospital of Sichuan University,Chengdu 610031,China)

机构地区：[1]四川大学华西医院呼吸内科,成都610031

出　　处：《药物流行病学杂志》2018年第12期785-792,共8页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:采用Meta分析方法评价不同他汀类药物治疗慢性阻塞性肺疾病(COPD)的有效性。方法:计算机检索Pub Med,Web of Science,Elsevier,The Cochrane Library,CNKI和Wan Fang Data数据库,搜集长期使用他汀类药物治疗COPD的队列或随机对照试验,检索时限均为建库至2018年2月。同时,追溯纳入研究的参考文献,进一步补充检索。由两位研究者独立对纳入文献进行偏倚风险评价、提取资料,采用Stata 12. 0软件进行Meta分析。结果:共纳入30项研究,223 823例患者。Meta分析结果显示,与仅用常规疗法相比,长期联用他汀类药物能有效降低COPD患者COPD加重风险[RR=0. 80,95%CI(0. 73,0. 89),P <0. 001]、COPD死亡风险[RR=0. 65,95%CI(0. 47,0. 90),P=0. 009]和全死因死亡风险[RR=0. 75,95%CI(0. 66,0. 87),P <0. 001]。与仅用常规疗法相比,分别长期联用阿托伐他汀、氟伐他汀和辛伐他汀均能降低COPD合并肺动脉高压(PH)患者的肺动脉压[阿托伐他汀:SMD=-0. 87,95%CI(-1. 24,-0. 51),P <0. 001;氟伐他汀:SMD=-0. 84,95%CI(-1. 33,-0. 35),P=0. 001;辛伐他汀:SMD=-1. 16,95%CI(-1. 49,-0. 83),P <0. 001],辛伐他汀效果更明显。结论:长期使用他汀类药物治疗COPD有效,且辛伐他汀更能有效降低COPD合并PH患者的肺动脉压。Objective: Systematic evaluation of the effectiveness of different statins in the treatment of chronic obstructive pulmonary disease( COPD). Methods: Pub Med,Web of Science,Elsevier,The Cochrane Library,CNKI and Wan Fang Data were electronically searched to collect cohorts and randomized controlled trials( RCTs) of long-term using statins for COPD from inception to February 2018,included in relevant literature references to futher broaden the search.Two researchers independently screened literature,extracted data and assessed risk of bias of included studies,then Metaanalysis was performed by Stata 12. 0 software. Results: Total of 30 cohorts and RCTs,223 823 patients were included.Meta-analysis showed that,compared with conventional treatment,statins could effectively reduce the risk of COPD exacerbations( RR = 0. 80,95% CI 0. 73 to 0. 89,P < 0. 001),COPD deaths( RR = 0. 65,95% CI 0. 47 to 0. 90,P = 0. 009)and all-cause mortality in patients with COPD( RR = 0. 75,95% CI 0. 66 to 0. 87,P < 0. 001). Compared with conventional treatment,atorvastatin,fluvastatin and simvastatin all reduced pulmonary artery pressure in COPD patients with pulmonary hypertension( PH)( atorvastatin: SMD =-0. 87,95% CI-1. 24 to-0. 51,P < 0. 001; fluvastatin: SMD =-0. 84,95% CI-1. 33 to-0. 35,P = 0. 001; simvastatin: SMD =-1. 16,95% CI-1. 49 to-0. 83,P < 0. 001),and simvastatin was more effective. Conclusion: Long-term use of statins for COPD is effective,and simvastatin is more effective in reducing pulmonary arterial pressure in COPD patients with PH.

关 键 词：他汀类药物 慢性阻塞性肺疾病 死亡 肺动脉高压 META分析 

分 类 号：R972.6[医药卫生—药品]