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李春杏,刘桦,纪立伟.他汀联合依折麦布与双倍剂量他汀对冠心病患者MACE影响的Meta分析[J].中国动脉硬化杂志,2019,(3):227~235
他汀联合依折麦布与双倍剂量他汀对冠心病患者MACE影响的Meta分析
Comparison of the effects of ezetimibe co-administered with statins versus statins dose-doubling on major adverse cardiovascular events in patients with coronary heart disease:a Meta-analysis
投稿时间:2018-08-31  修订日期:2018-12-18
DOI:
中文关键词:  依折麦布  他汀  双倍剂量  冠心病  主要不良心血管事件  Meta分析
英文关键词:ezetimibe  statins  double dose  coronary heart disease  major adverse cardiovascular events  Meta-analysis
基金项目:北京市科技计划课题(D181100000218003)
作者单位E-mail
李春杏 航天中心医院药剂科,北京市 100049 e-mail为2008yuejuan@163.com,e-mail为jlw1228@sina.com 
刘桦 航天中心医院药剂科,北京市 100049  
纪立伟 北京医院药学部 国家老年医学中心,北京市 100730 e-mail为2008yuejuan@163.com,e-mail为jlw1228@sina.com 
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中文摘要:
      目的 系统评价他汀联合依折麦布与双倍剂量他汀对冠心病患者主要不良心血管事件(MACE)的影响,为临床治疗提供参考。方法 计算机检索The Cochrane Library、PubMed、Embase、CNKI、CSTJ、CBMdisc以及万方医学网,收集他汀联合依折麦布(联合组)对比双倍剂量他汀(他汀组)治疗冠心病患者的随机对照研究,提取相关资料并按照修改后的Jadad 评分量表评价纳入研究质量,采用RevMan 5.3软件进行Meta分析。结果 共纳入29篇30项随机对照研究,合计4 757例患者。Meta分析结果显示,与他汀组比较,联合组MACE(P=0.03)、再发心绞痛(P<0.001)和再发心肌梗死(P<0.001)明显降低;而两组心源性死亡、血运重建、心力衰竭及卒中发生率差异无显著性。与他汀组比较,联合组转氨酶升高(P<0.001)、肌酸激酶升高(P=0.02)和肌损伤发生率(P<0.001)等显著降低。根据他汀种类和剂量进行亚组分析,结果显示,10 mg依折麦布+20 mg阿托伐他汀组降低MACE(P=0.02)、心肌梗死发生率(P=0.003)较阿托伐他汀40 mg组更具优势。随访时间长短对研究结果未见影响。结论 对于冠心病患者,联合组治疗较他汀组在心绞痛、心肌梗死方面获益明显,心源性死亡和卒中方面差异无显著性,且不良反应发生率显著减少。
英文摘要:
      Aim To evaluate the effects of ezetimibe co-administered with statins vs statins dose-doubling on major adverse cardiovascular events in patients with coronary heart disease systematically, in order to provide evidence-based reference for clinical use. Methods The pertinent randomized controlled trials (RCTs) about ezetimibe co-administered with statins trail group and statins dose-doubling control group in the treatment of coronary heart disease were retrieved from The Cochrane Library, PubMed, Embase, CNKI, CSTJ, CBMdisc and Wan fang Database. The quality of included studies were evaluated according to modified Jadad quality scale after extracting data. Meta-analysis was performed by using RevMan 5.3 statistical software. Results A total of 30 RCTs were included,involving 4 757 patients. The results of Meta-analysis showed that compared with double-dose statins, ezetimibe-plus-statins markedly decrease major adverse cardiovascular events(P=0.03), angina(P<0.001) and myocardial infarction(P<0.001); the incidence of cardiac death, revascularization, heart failure and stroke had no significant difference in two groups; ezetimibe-plus-statins significantly decrease adverse reactions, such as transaminase elevation(P<0.001), creatine kinase elevation(P=0.02), and muscle pain, muscle weakness and other muscle injuries(P<0.001). Meta-analysis in subgroup was studied according to the kinds and dosage of statins and follow-up time, compared with atorvastatin 40 mg, ezetimibe 10 mg plus atorvastatin 20 mg showed more advantages in reducing the incidence of major adverse cardiovascular events and myocardial infarction than other subgroups. However, no effect was found on the results between a long follow-up time (≥6 months) with a short follow-up time (≤3 months). Conclusions For patients with coronary heart disease, statins combined with ezetimibe has a significant benefit in myocardial infarction and angina compared with double dose statins, but the benefit of cardiac death and stroke were not found. The incidence of adverse reactions is significantly reduced.
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