強(qiáng)化劑量他汀類藥物治療急性冠狀動(dòng)脈綜合征患者的有效性及安全性meta分析
發(fā)布時(shí)間：2018-12-06 20:03
【摘要】：背景:急性冠脈綜合征(ACS)起病急驟,血清膽固醇水平及動(dòng)脈粥樣硬化斑塊形成是其主要的危險(xiǎn)因素。他汀類藥物能夠有效地降低膽固醇水平及穩(wěn)定動(dòng)脈粥樣硬化斑塊,同時(shí)還可以降低心血管事件的發(fā)生風(fēng)險(xiǎn)。近年來(lái),強(qiáng)化劑量的他汀治療已經(jīng)逐步應(yīng)用于西方發(fā)達(dá)國(guó)家,而我國(guó)仍處于常規(guī)劑量的治療階段。因此,對(duì)于ACS患者強(qiáng)化劑量他汀治療是否較常規(guī)劑量他汀治療能帶來(lái)更大的獲益及安全性值得我們進(jìn)一步思考。目的:本研究擬收集相關(guān)RCT研究,針對(duì)強(qiáng)化劑量及常規(guī)劑量他汀治療ACS患者的有效性及安全性進(jìn)行meta分析,分析比較兩組的降脂療效和不良反應(yīng)的發(fā)生情況。方法:全面檢索Cochrane Library、PubMed、EMBASE、Web of Science、中國(guó)知網(wǎng)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、維普數(shù)據(jù)庫(kù)(VIP)。檢索時(shí)限為各數(shù)據(jù)庫(kù)建庫(kù)時(shí)間至2017年2月27日。兩名研究者依據(jù)納入和排除標(biāo)準(zhǔn)篩選及提取相關(guān)數(shù)據(jù)。文獻(xiàn)質(zhì)量評(píng)價(jià)采用Cochrane協(xié)作網(wǎng)偏倚風(fēng)險(xiǎn)評(píng)價(jià)工具進(jìn)行。定量分析依據(jù)異質(zhì)性檢驗(yàn)及I2選擇相對(duì)應(yīng)的效應(yīng)模型進(jìn)行分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:按照納入與排除標(biāo)準(zhǔn)最終納入8篇RCT,共9442例ACS患者。定量分析結(jié)果表明:有效性方面,強(qiáng)化劑量較常規(guī)劑量能更加顯著的降低LDL-C(SMD=-0.76,95%CI:-1.04~-0.48,I2=96%)、TC(SMD=-0.66,95%CI:-0.72~-0.60,I2=18%)及TG(SMD=-0.20,95%CI:-0.25~-0.14,I2=0%)水平,HDL-C(SMD=0.01,95%CI:-0.05~0.06,I2=50%)水平在兩組之間差異無(wú)統(tǒng)計(jì)學(xué)意義;安全性方面,強(qiáng)化劑量較常規(guī)劑量能更加顯著降低全因死亡率(RR=0.75,95%CI:0.61~0.93,I2=0%)、MACE(RR=0.85,95%CI:0.76~0.96,I2=19%)、心源性死亡(RR=0.75,95%CI:0.59~0.95,I2=0%)及冠脈重建術(shù)(RR=0.87,95%CI:0.76~0.99,I2=0%)的發(fā)生風(fēng)險(xiǎn),然而大劑量的他汀類藥物治療更加容易發(fā)生肝功能異常(RR=2.76,95%CI:1.85~4.12,I2=0%),同時(shí),心肌梗死(RR=0.90,95%CI:0.78~1.05,I2=17%)、中風(fēng)(RR=0.84,95%CI:0.58~1.21,I2=0%)及肌肉不良反應(yīng)(RR=1.20,95%CI:0.91~1.58,I2=0%)在兩組之間差異無(wú)統(tǒng)計(jì)學(xué)意義。敏感性分析提示本研究的結(jié)果穩(wěn)健,具有較高的可信度。結(jié)論:強(qiáng)化劑量較常規(guī)劑量能更加顯著的降低LDL-C、TC及TG水平;同時(shí),強(qiáng)化劑量與常規(guī)劑量組相比較更優(yōu)于降低全因死亡率、MACE、心源性死亡及冠脈重建術(shù)的發(fā)生風(fēng)險(xiǎn),盡管強(qiáng)化劑量治療更加容易發(fā)生肝功能異常。對(duì)于ACS患者進(jìn)行強(qiáng)化劑量的他汀類藥物治療可以帶來(lái)更大的獲益,但同時(shí)也需密切監(jiān)測(cè)肝功能的變化。上述結(jié)果仍需更多高質(zhì)量、多中心、大樣本的RCT進(jìn)一步證實(shí)。
[Abstract]:Background: acute coronary syndrome (ACS) is a major risk factor for acute coronary syndrome (ACS). Serum cholesterol level and atherosclerotic plaque formation are the main risk factors. Statins can effectively reduce cholesterol levels and stabilize atherosclerotic plaques, as well as reduce the risk of cardiovascular events. In recent years, statin therapy with intensive dose has been gradually applied in western developed countries, but it is still in the stage of routine dose therapy in China. Therefore, whether the intensive dose of statins in patients with ACS can bring more benefits and safety than the conventional dose of statins deserves further consideration. Objective: to collect relevant RCT studies and to analyze the efficacy and safety of statin in the treatment of ACS by meta, and to compare the effect of lipid-lowering and the occurrence of adverse reactions between the two groups. Methods: a comprehensive search for Cochrane Library,PubMed,EMBASE,Web of Science, China knowledge Network, China Biomedical Literature Database, (CBM), Weip Database (VIP). The time limit for retrieval is the time for each database to be built up to February 27, 2017. The two researchers screened and extracted data based on inclusion and exclusion criteria. The evaluation of literature quality was carried out with the Cochrane collaboration Network bias risk Assessment tool. Quantitative analysis was based on heterogeneity test and I2 selection of the corresponding effect model analysis. P0.05 as the difference was statistically significant. Results: 9442 patients with ACS were included in 8 RCT, according to inclusion and exclusion criteria. The results of quantitative analysis show that the amount of enhancer can significantly reduce LDL-C (SMD=-0.76,95%CI:-1.04~-0.48,I2=96%), TC (SMD=-0.66,95%CI:-0.72~-0.60,) compared with the conventional dose in terms of effectiveness. There was no significant difference between the two groups in the levels of I2P (18%), TG (SMD=-0.20,95%CI:-0.25~-0.14,I2=0%) and HDL-C (SMD=0.01,95%CI:-0.05~0.06,I2=50%). In terms of safety, the dose of enhancer significantly reduced the all-cause mortality (RR=0.75,95%CI:0.61~0.93,I2=0%), MACE (RR=0.85,95%CI:0.76~0.96,I2=19%) compared with the conventional dose. Risk of cardiac death (RR=0.75,95%CI:0.59~0.95,I2=0%) and coronary artery reconstruction (RR=0.87,95%CI:0.76~0.99,I2=0%), However, large doses of statins are more likely to cause liver dysfunction (RR=2.76,95%CI:1.85~4.12,I2=0%) and myocardial infarction (RR=0.90,95%CI:0.78~1.05,I2=17%). There was no significant difference in stroke (RR=0.84,95%CI:0.58~1.21,I2=0%) and muscle adverse reaction (RR=1.20,95%CI:0.91~1.58,I2=0%) between the two groups. Sensitivity analysis shows that the results of this study are robust and reliable. Conclusion: the level of LDL-C,TC and TG can be significantly decreased by the dosage of fortifier compared with the conventional dose. At the same time, the enhanced dose is better than the conventional dose group in reducing the all-cause mortality, MACE, cardiogenic death and the risk of coronary artery reconstruction, although the enhanced dose treatment is more prone to liver dysfunction. Intensive doses of statins in patients with ACS can benefit more, but changes in liver function also need to be closely monitored. These results need to be further confirmed by high quality, multi-center, and large sample RCT.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
本文編號(hào)：2366581
[Abstract]:Background: acute coronary syndrome (ACS) is a major risk factor for acute coronary syndrome (ACS). Serum cholesterol level and atherosclerotic plaque formation are the main risk factors. Statins can effectively reduce cholesterol levels and stabilize atherosclerotic plaques, as well as reduce the risk of cardiovascular events. In recent years, statin therapy with intensive dose has been gradually applied in western developed countries, but it is still in the stage of routine dose therapy in China. Therefore, whether the intensive dose of statins in patients with ACS can bring more benefits and safety than the conventional dose of statins deserves further consideration. Objective: to collect relevant RCT studies and to analyze the efficacy and safety of statin in the treatment of ACS by meta, and to compare the effect of lipid-lowering and the occurrence of adverse reactions between the two groups. Methods: a comprehensive search for Cochrane Library,PubMed,EMBASE,Web of Science, China knowledge Network, China Biomedical Literature Database, (CBM), Weip Database (VIP). The time limit for retrieval is the time for each database to be built up to February 27, 2017. The two researchers screened and extracted data based on inclusion and exclusion criteria. The evaluation of literature quality was carried out with the Cochrane collaboration Network bias risk Assessment tool. Quantitative analysis was based on heterogeneity test and I2 selection of the corresponding effect model analysis. P0.05 as the difference was statistically significant. Results: 9442 patients with ACS were included in 8 RCT, according to inclusion and exclusion criteria. The results of quantitative analysis show that the amount of enhancer can significantly reduce LDL-C (SMD=-0.76,95%CI:-1.04~-0.48,I2=96%), TC (SMD=-0.66,95%CI:-0.72~-0.60,) compared with the conventional dose in terms of effectiveness. There was no significant difference between the two groups in the levels of I2P (18%), TG (SMD=-0.20,95%CI:-0.25~-0.14,I2=0%) and HDL-C (SMD=0.01,95%CI:-0.05~0.06,I2=50%). In terms of safety, the dose of enhancer significantly reduced the all-cause mortality (RR=0.75,95%CI:0.61~0.93,I2=0%), MACE (RR=0.85,95%CI:0.76~0.96,I2=19%) compared with the conventional dose. Risk of cardiac death (RR=0.75,95%CI:0.59~0.95,I2=0%) and coronary artery reconstruction (RR=0.87,95%CI:0.76~0.99,I2=0%), However, large doses of statins are more likely to cause liver dysfunction (RR=2.76,95%CI:1.85~4.12,I2=0%) and myocardial infarction (RR=0.90,95%CI:0.78~1.05,I2=17%). There was no significant difference in stroke (RR=0.84,95%CI:0.58~1.21,I2=0%) and muscle adverse reaction (RR=1.20,95%CI:0.91~1.58,I2=0%) between the two groups. Sensitivity analysis shows that the results of this study are robust and reliable. Conclusion: the level of LDL-C,TC and TG can be significantly decreased by the dosage of fortifier compared with the conventional dose. At the same time, the enhanced dose is better than the conventional dose group in reducing the all-cause mortality, MACE, cardiogenic death and the risk of coronary artery reconstruction, although the enhanced dose treatment is more prone to liver dysfunction. Intensive doses of statins in patients with ACS can benefit more, but changes in liver function also need to be closely monitored. These results need to be further confirmed by high quality, multi-center, and large sample RCT.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 宋炳慧;宋曉光;賈珊珊;魏冬梅;;不同劑量瑞舒伐他汀鈣對(duì)不穩(wěn)定型心絞痛患者的血脂、血清高敏C-反應(yīng)蛋白及同型半胱氨酸的影響[J];中外醫(yī)療;2016年11期
2 楊云紅;李興德;;依折麥布的研究進(jìn)展[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2015年25期
3 霍勇;葛均波;韓雅玲;王建安;萬(wàn)征;李建平;錢菊英;王斌;項(xiàng)美香;孫躍民;代表《急性冠狀動(dòng)脈綜合征患者強(qiáng)化他汀治療專家共識(shí)》專家組;;急性冠狀動(dòng)脈綜合征患者強(qiáng)化他汀治療專家共識(shí)[J];中國(guó)介入心臟病學(xué)雜志;2014年01期
4 吳志紅;孫玉然;連曉芳;王香玲;任巖春;都偉;王云英;安少波;徐雷;;不同劑量瑞舒伐他汀對(duì)老年不穩(wěn)定型心絞痛患者血清同型半胱氨酸及高敏C-反應(yīng)蛋白水平的影響[J];疑難病雜志;2013年10期
5 戴煒;常雪君;;四種他汀類藥物治療導(dǎo)致肝功能異常的比較研究[J];山西醫(yī)藥雜志;2013年10期
6 李華偉;;中老年急性冠脈綜合征早期應(yīng)用中等劑量普伐他汀的臨床意義[J];吉林醫(yī)學(xué);2012年32期
7 郭藝芳;胡大一;;膽固醇吸收抑制劑臨床應(yīng)用中國(guó)專家共識(shí)[J];心腦血管病防治;2010年03期
8 ;中國(guó)成人血脂異常防治指南[J];中華心血管病雜志;2007年05期
9 徐成斌;調(diào)脂治療防治冠心病重點(diǎn)在低密度脂蛋白膽固醇[J];中華心血管病雜志;2003年05期
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