目的 探讨瑞舒伐他汀大剂量（20 mg/d）对比常规剂量（10 mg/d）对中国急性心肌梗死患者经皮冠状动脉介入（PCI）术后的影响，寻找适合中国人群剂量。方法 计算机检索PubMed、Cochrane library、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普数据库（VIP）、万方数据库等数据库关于急性心肌梗死患者PCI术后应用不同剂量瑞舒伐他汀的临床随机对照试验（RCT），检索时间从建库至2019年10月，应用Revmen 5.3软件针对左心室射血分数（LVEF%）、心肌梗死溶栓试验（TIMI）分级3级、N末端脑钠肽前体（NT-proBNP）、基质金属蛋白酶-9（MMP-9）、超敏C-反应蛋白（hs-CRP）、主要不良心血管事件（MACE）发生率及不良反应发生率进行Meta-分析。结果 共纳入16项RCTs，1 588例患者。Meta-分析结果显示：与10 mg瑞舒伐他汀相比，20 mg该药能增加LVEF%（MD=4.30， 95% CI=3.67～7.23），增加TIMI分级3级百分比（OR=5.73，95% CI=3.26～10.08），减少NT-pro BNP水平（MD=-92.83， 95% CI=-120.49～-65.16），减少MMP-9水平（MD=-20.24，95% CI=-25.39～-15.09），减少hs-CRP水平（MD=-1.55， 95% CI=-2.06～-1.04），减少MACE发生率（OR=0.25，95% CI=0.16～0.39），两组比较差异均有统计学意义（P<0.01）；两组间不良反应的差异无统计学意义。结论 对于中国急性心肌梗死行PCI患者，20 mg/d瑞舒伐他汀的临床疗效优于标准剂量（10 mg/d），且安全性相当。

Objective To determine the effect and safety of rosuvastatin at high does (20 mg/d) and regular doses (10 mg/d) on acute myocardial infarction with percutaneous coronary intervention (PCI) in Chinese patients in order to explore a safe and effective dose of rosuvastatin for Chinese population. Methods Searched databases such as PubMed, Cochrane Library, CNKI, CMB, VIP and Wanfang Database about randomized controlled trials (RCTs) of different doses of rosuvastatin after PCI in Chinese patients with acute myocardial infarction from inception to October 2019. The Meta-analysis evaluation software Revman 5.3 was applied to analyzed the obtained studies. The changes of left ventricular ejection fraction (LVEF%), thrombolysis in myocardial infarction (TIMI) grade 3, N-terminal brain natriuretic peptide precursor (NT-pro BNP), matrix metallo- proteinase-9 (MMP-9), hypersensitive C-reactive protein (hs-CRP), incidence of major adverse cardiovascular events (MACE) and side effects after different doses of rosuvastatin treatment were compared in different doses. Results A total of 16 RCTs involving 1 588 patients were entered. Metaanalysis showed that high does rosuvastatin significant increase in LVEF% levels (MD=4.30, 95%CI=3.67, 7.23) and TIMI rating by 3 percent (OR=5.73, 95%CI=3.26, 10.08); reduction in NT-pro BNP levels (MD=-92.83, 95%CI=-120.49, -65.16), MMP-9 levels (MD=-20.24, 95%CI=-25.39, -15.09), hs-CRP levels (MD=-1.55,95%CI=-2.06, -1.04) and rate of MACE (OR=0.25, 95%CI=0.16, 0.39) when compared with regular doses rosuvastatin (P<0. 001). There was no significant difference in the incidence of side effects between the two doses. Conclusion For Chinese patients with acute myocardial infarction undergoing PCI, the clinical efficacy of rosuvastatin at 20 mg/d is better than the standard dose (10 mg/d), and the safety is comparable.

R972