[关键词]
[摘要]
目的 评价阿托伐他汀治疗心肌梗死后心力衰竭患者的有效性,为该病患者的循证治疗提供证据。方法 计算机检索PubMed、Cochrane图书馆、EMbase、中国学术期刊全文数据库(CNKI)、万方数据库(Wanfang)、维普中文科技期刊数据库(VIP)等数据库中的随机对照试验(RCT),检索时限均从建库至2018年10月。采用RevMan 5.3软件进行Meta-分析,客观评价其临床疗效。结果 共纳入22个RCTs,10 971例患者。对其中20个RCTs进行Meta-分析,结果显示:(1)与常规治疗组相比,阿托伐他汀组的左室射血分数(LVEF)、6 min步行距离明显增加[MD=7.56,95% CI(4.13,10.98),P<0.000 1;MD=20.06,95% CI(9.77,30.35),P=0.000 1],N末端脑钠肽(NT-proBNP)、脑钠肽(BNP)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)值明显减小[MD=-153.23,95% CI(-186.97,-119.49),P<0.00001;MD=-96.74,95% CI(-117.10,-76.38),P<0.00001;MD=-5.69,95% CI(-8.11,-3.27),P<0.000 01;MD=-6.80,95% CI(-8.65,-4.95),P<0.000 01];(2)有7个研究涉及阿托伐他汀的剂量,与40 mg治疗组相比20 mg治疗组的LVEDD、LVESD、NT-proBNP、BNP明显减少[MD=-5.13,95% CI(-6.05,-4.21),P<0.000 01;MD=-0.84,95% CI(-1.50,-0.17),P=0.01;MD=-26.53,95% CI(-47.68,-5.37),P=0.01;MD=-17.63,95% CI(-32.66,-2.59),P=0.02],LVEF及6 min步行距离明显增加[MD=9.13,95% CI(7.95,10.31),P<0.000 01;MD=22.24,95% CI(7.06,37.43),P=0.0004]。定性分析结果显示阿托伐他汀可有效改善心肌梗死后心力衰竭的临床症状及患者心功能状况。结论 阿托伐他汀对心肌梗死后心力衰竭患者治疗效果显著,且可以有效预防无症状型心力衰竭进一步发展,但上述结论尚需更多大样本高质量的临床试验加以验证。
[Key word]
[Abstract]
Objective To evaluate the efficacy of attovastatin in the treatment of patients with heart failure after myocardial infarction, and to provide reliable evidence for evidence-based treatment of those patient. Methods The randomized controlled trial (RCT) were searched from PubMed, Cochrane Library, EMbase, CNKI, Wanfang, VIP and other databases. The time limit for retrieval is from the construction of the database to October 2018. This study was carried out with RevMan 5.3 software to evaluated its clinical efficacy objectively. Results A total of 22 RCTs were included, involving 10 971 patients. The results of Meta-analysis with 20 RCTs showed that:(1) Compared with the routine treatment group, the six-minute walking distance and the left ventricular ejection fraction (LVEF), in attovastatin group was significantly increased[MD=7.56, 95%CI(4.13, 10.98), P<0.0001; MD=20.06, 95%CI(9.77, 30.35), P=0.000 1]. And the N-terminal brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), left ventricular end-diastolic diameter (LVEDD), the left ventricular end systolic diameter (LVEDS) significantly decreased[MD=-153.23, 95%CI (-186.97, -119.49), P<0.000 01; MD=-96.74, 95%CI (-117.10, -76.38), P<0.000 01; MD=-5.69, 95%CI (-8.11, -3.27), P<0.000 01; MD=-6.80, 95%CI (-8.65, -4.95), P<0.000 01]. (2) Seven of the RCTs involved different doses of attovastatin showed the LVEDD, LVESD, NT-proBNP, BNP of 20 mg groups were significantly lower than those of 40 mg groups[MD=-5.13, 95%CI (-6.05, -4.21), P<0.000 01; MD=-0.84, 95%CI (-1.50, -0.17), P=0.01; MD=-26.53, 95%CI (-47.68, -5.37), P=0.01; MD=-17.63, 95%CI (-32.66, -2.59), P=0.02]; LVEF and six-minute walking distance was markedly increased[MD=9.13, 95%CI (7.95, 10.31), P<0.000 01; MD=22.24, 95%CI (7.06, 37.43), P=0.0004]. The results of qualitative analysis showed that attovastatin could effectively improve the clinical symptoms and cardiac function of patients with heart failure after myocardial infarction. Conclusion attovastatin is effective in the treatment of heart failure patients after myocardial infarction, which can effectively prevent the further development of asymptomatic heart failure. However, these conclusions need to be verified by more large samples and high quality clinical trials.
[中图分类号]
R954
[基金项目]
国家重点研发计划"中医药现代化研究"重点专项课题(2017YFC1700402)