他汀类药物辅助治疗肺炎或脓毒症疗效的Meta分析  

Meta-analysis on curative effects of statins in treatment of pneumoniaor or sepsis

作　　者：邱立洁 张也[2] 张文静[1] 钱东华[1] 

机构地区：[1]吉林大学第一医院呼吸内科,吉林长春130021 [2]吉林大学第一医院内分泌代谢科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2016年第2期336-344,共9页Journal of Jilin University：Medicine Edition

基　　金：吉林省卫生厅科研基金资助课题(2010Z031)

摘　　要：目的:系统评价他汀类药物治疗肺炎或脓毒症的效果,为他汀类药物治疗肺炎或脓毒症提供相关的循证医学依据。方法:应用PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、万方数据库和中国知网等数据库检索从建库至2015年1月31日发表的关于他汀类药物的临床随机对照研究。由2位研究者分别按照纳入及排除标准独立进行文献筛查、数据提取及质量评价后进行检索结果汇总,使用Cochrane协作网提供的软件Review Manager 5.3对纳入文献进行数据的处理及统计分析。结果:有9项研究共1 227例患者纳入研究。(1)共纳入6项研究对住院期间死亡率进行Meta分析,他汀类药物较对照组未能降低肺炎或脓毒症患者住院期间死亡率;相对危险度(RR)=0.83,95%CI(0.63,1.08),P=0.17。(2)共纳入7项研究对机械通气及入住ICU的需求进行Meta分析,他汀类药物较对照组在改善细菌感染患者机械通气及入住ICU方面未见明显效果;RR=0.99,95%CI(0.96,1.03),P=0.62。(3)共纳入4项研究对超敏C反应蛋白(CRP)水平进行Meta分析,与安慰剂组比较,他汀类药物可明显降低CRP水平;均数差(MD)=-8.30 mg·L^(-1),95%CI-12.13,-4.47),P<0.000 1。结论:他汀类药物不能降低肺炎或脓毒症患者住院期间死亡率及机械通气或入住ICU次数,但可以降低肺炎或脓毒症患者的CRP水平并减轻全身炎症反应。Objective： To systematically review the effects of statins in the treatment of the patients with pneumonia or sepsis, and to provide evidence-based basis for the using of statin in treatment of pneumonia or sepsis. Methods： PubMed, Embase, The Cochrane Library, CNKI, WanFang Data and VIP were searched for randomized placebo-controlled trials of statins published from the establishment time of datebases to January 31, 2015. The qualities of the included studies were independently assessed by two reviewers and the relevant data was extracted for analysis using Review Manager 5.3. Results： Nine trails involving a total of 1 227 patients were included. （DA total of 6 studies about the mortality of hospitalized patients were included in the Meta analysis： compared with placebo group, statins didn＇t improve the mortality of hospitalized patients with pneumonia or sepsis; risk ratio （RR） = 0.83, 95%CI （0.63, 1.08）, P=0.17.A total of 7 studies about the rates of mechanical ventilation usage or ICU admission of the patients were included in the Meta-analysis. Compared with placebo group, statins didn＇ t improve the rates of mechanical ventilation usage or ICU admission of the patients with bacteria infection; RR = 0.99, 95% CI （0.96, 1.03）, P=0.62. A total of 4 studies about the levels of C reaction protein （CRP） were included in the Meta-analysis. Compared with placebo group, statins significantly reduced the levels of CRP; mean differences （MD） =-8.30 mg ·L-1, 95MCI （-12.13, -4.47）, P〈0. 0001. Oonclusion; Statins can not significantly reduce both the in-hospital mortality and the rates of mechanical ventilation usage or ICU admission, but can significantly reduce the plasma CRP levels, and reduce the inflammation.

关 键 词：他汀类 肺炎 脓毒症 META分析 

分 类 号：R563.1[医药卫生—呼吸系统]