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目的:综合评估他汀对慢性心力衰竭(心衰)患者临床事件、心脏功能和炎症指标的作用。方法:以“heart failure、hydroxymethylglutaryl-CoA reductase inhibitors、randomized controlled trial”等为主题词联合关键词检索数据库PubMed、EMBASE和Cochrane library,应用Review Manager5.3软件和Stata13.0软件对纳入文献进行meta分析。结果:最终纳入21篇文献,meta分析显示:①他汀降低临床事件发生风险:因心衰住院风险[RR:0.84(0.70,0.99),P=0.04]和全因死亡风险(仅亲脂性他汀)[RR:0.58(0.41,0.82),P=0.002],但目前证据尚不足以证明他汀可降低心衰患者的心血管死亡风险[RR:0.97(0.90,1.04),P=0.37];②他汀改善心脏功能:提高左室射血分数(LVEF)[MD:2.89(1.37,4.41),P=0.000 2],减低B型利钠肽(BNP)[SMD:-0.26(-0.44,-0.07),P=0.006];③降低炎性因子水平:高敏C反应蛋白(hs-CRP)[SMD:-0.39(-0.58,-0.20),P<0.0001]和肿瘤坏死因子α(TNF-α)[SMD:-0.77(-1.07,-0.48),P<0.000 01]较对照组均降低;④亚组分析发现年龄<65岁、基础LVEF≥30%的心衰患者更易从他汀治疗中获益;相对于亲水性他汀,患者更易从亲脂性他汀治疗中获益。结论:他汀可使心衰患者临床获益,但患者年龄、基础LVEF水平及他汀类型等均可影响药物疗效。
Objective: To evaluate the effects of statins on clinical events, cardiac function and inflammation in patients with chronic heart failure (CHF). METHODS: The database of PubMed, EMBASE and Cochrane databases was searched with the keywords “heart failure, hydroxymethylglutaryl-CoA reductase inhibitors, randomized controlled trial” and so on. The review was conducted using Review Manager 5.3 software and Stata 13.0 software meta analysis Results: A total of 21 articles were included in the meta-analysis. (1) Statins reduced the risk of clinical events: the risk of hospitalization for heart failure [RR: 0.84 (0.70,0.99), P = 0.04] and all-cause mortality [RR: 0.58 (0.41, 0.82), P = 0.002], but there is insufficient evidence that statins reduce the risk of cardiovascular death in patients with HF [RR: 0.97 (0.90, 1.04), P = 0.37] (LVEF) [MD: 2.89 (1.37, 4.41), P = 0.0002] and decreased BNP (SMD: -0.26 (-0.44, -0.07) , P = 0.006]; ③ reduce the level of inflammatory factors: high sensitivity C-reactive protein (hs-CRP) [SMD: -0.39 (-0.58, -0.20), P <0.0001] and tumor necrosis factor alpha SMD: -0.77 (-1.07, -0.48), P <0.000 01] were lower than those in the control group. (4) Subgroup analysis found that patients with heart failure <65 years old and basic LVEF≥30% were more likely to benefit from statin treatment; Patients are more likely to benefit from lipophilic statin therapy than with hydrophilic statins. Conclusion: Statin can benefit patients with heart failure. However, patients’ age, basal LVEF level and statin type may affect the efficacy of the drug.