他汀类药物对稳定期慢性阻塞性肺病治疗效果的Meta分析

doi:10.6040/j.issn.1671-7554.0.2014.614

摘要/Abstract

摘要： 目的荟萃分析他汀类药物对稳定期慢性阻塞性肺疾病(COPD)患者肺功能、急性加重情况、炎性因子、临床症状等方面的作用.方法检索自建库至2014年11月PubMed、Cochrane Library、CNKI、万方以及中文科技期刊数据库发表的随机对照研究(RCTs),评价他汀类药物对稳定期COPD患者的治疗效果.由2名评价员独立筛选检索到的文献,并评价质量、提取数据及交叉核对.使用RevMan 5.2统计软件处理数据.结果共纳入12项研究,1 589例患者.经他汀类药物治疗后,稳定期COPD患者第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积占预计值百分比(FEV₁%pred)无明显改善;急性加重情况无显著改善;炎性因子CRP水平降低(WMD为-1.62,95%CI为-1.90~-1.34),TNF-α水平降低(WMD为-5.31,95%CI为-9.45~-1.17),IL-6水平降低(WMD为-0.46,95%CI为-0.89~-0.03);呼吸困难程度及健康相关的生活质量有一定改善.结论他汀类药物可以降低稳定期COPD患者的炎症水平,改善其临床症状,但对肺功能及急性加重情况无明显改善.

关键词: 肺疾病,慢性阻塞性, 他汀, 稳定期, Meta分析

Abstract: Objective To evaluate the effects of statins treatment on pulmonary function, exacerbation, inflammatory factors, and health conditions in stable patients with chronic obstructive pulmonary disease (COPD). Methods Databases of PubMed, Cochrane Library, CNKI, Wanfang and VIP were searched up from the day of database construction to November, 2014. Randomized controlled trials (RCTs) which investigated the effects of statins treatment on stable COPD patients were identified. Two independent reviewers screened the retrieved literatures, measured the quality, extracted the data and cross-checked them. RevMan 5.2 statistical software was used to analysis the data. Results Twelve RCTs, including 1 589 patients, were included. Statins treatment reduced the levels of blood inflammatory factors, including serum CRP (WMD:-1.62; 95%CI:-1.90 to -1.34), plasma TNF-α(WMD: -5.31; 95%CI:-9.45 to -1.17) and serum IL-6 (WMD:-0.46; 95%CI:-0.89 to -0.03), alleviated the clinical symptoms, reduced the degree of dyspnea, and improved the life quality. Statins treatment could not improve the forced expiratory volume in 1 second (FEV₁), FEV₁% predicted (FEV₁%pred) and exacerbation. Conclusion Statins treatment has anti-inflammatory effects and can alleviate clinical symptoms, but has no significant effects on reversing the decline of pulmonary function and preventing exacerbation in stable COPD patients.

Key words: Pulmonary disease, chronic obstructive, Statin, Meta analysis, Stable

中图分类号:

R563

吴珍, 宋国栋, 王伟. 他汀类药物对稳定期慢性阻塞性肺病治疗效果的Meta分析[J]. 山东大学学报（医学版）, 2015, 53(2): 12-18.

WU Zhen, SONG Guodong, WANG Wei. Effects of statins on patients with chronic obstructive pulmonary disease: a Meta analysis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(2): 12-18.

参考文献

[1] World Health Organization. World health statistics 2008[EB/OL]. http://www.who.int/whosis/ whostat/EN_WHS08_Full.pdf, 2008-05-20/2013-12-10.
[2] Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials:a systematic review [J]. Phys Ther, 2008, 88(2):156-175.
[3] Criner GJ, Connett JE, Aaron SD, et al. Simvastatin for the prevention of exacerbations in moderate-to-severe COPD [J]. N Engl J Med, 2014, 370(23):2201-2210.
[4] Moosavi SA, Raji H, Faghankhani M, et al. Evaluation of the effects of atorvastatin on the treatment of secondary pulmonary hypertension due to chronic obstructive pulmonary diseases:a randomized controlled trial [J]. Iran Red Crescent Med J, 2013, 15(8):649-654.
[5] Kaczmarek P, Sladek K, Skucha W, et al. The influence of simvastatin on selected inflammatory markers in patients with chronic obstructive pulmonary disease [J]. Pol Arch Med Wewn, 2010, 120(1-2):11-17.
[6] Lee TM, Lin MS, Chang NC. Usefulness of C-reactive protein and interleukin-6 as predictors of outcomes in patients with chronic obstructive pulmonary disease receiving pravastatin[J]. Am J Cardiol, 2008, 101(4):530-535.
[7] 陈植涛,唐盛发.辛伐他汀对COPD稳定期患者的干预作用临床研究[J].右江民族医学院学报, 2011, 33(4):420-422. CHEN Zhitao, TANG Shengfa. The effects of simvastatin intervention in patients with chronic obstructive pulmonary disease in stationary phase [J]. Journal of Youjiang Medical University for Nationalities, 2011, 33(4):420-422.
[8] 蒋智敏,历风元,童旭芳,等.辛伐他汀对慢性阻塞性肺疾病肺功能的影响及作用机制研究[J].海南医学, 2013, 24(9):1277-1279. JIANG Zhimin, LI Fengyuan, TONG Xufang, et al. Effect of simvastatin on pulmonary function in patients with chronic obstructive pulmonary disease in stationary phase and study on mechanism[J]. Hainan Medical Journal, 2013, 24(9):1277-1279.
[9] 金雪梅,李晓佳.辛伐他汀治疗慢性阻塞性肺疾病患者疗效观察[J].临床肺科杂志, 2011, 16(7):1012-1014. JIN Xuemei, LI Xiaojia. Curative effect observation of simvastatin treatment of chronic obstructive pulmonary disease [J]. Journal of Clinical Pulmonary Medicine, 2011, 16(7):1012-1014.
[10] 门雪琳,王永瑞.辛伐他汀对慢性阻塞性肺病患者缓解期的影响研究[J].实用心脑血管病杂志, 2011, 19(4):554-555. MEM Xuelin, WANG Yongrui. The influence of simvastatin with stable COPD patient [J]. Practical Journal of Cardiac Cerebral Pneumal And Vascular Disease, 2011, 19(4):554-555.
[11] 王永彬.辛伐他汀对COPD患者可溶性Fas及气道炎症的干预作用[D].济南:山东大学医学院,2009. WANG Yongbin. The effects of simvastatin on plasma soluble fas and airway inflammation in patients with chronic obstructive pulmonary disease[D]. Jinan: School of Medicine, Shandong University, 2009.
[12] 徐建荣,郑赣红,颜胜君,等.氟伐他汀对慢性阻塞性肺疾病稳定期患者肺功能及白细胞介素-6的影响[J].中国医药导报, 2012, 9(25):98-99. XU Jianrong, ZHENG Ganhong, YAN Shengjun, et al. The effect of fluvastatin on pulmonary function and interleukin-6 levels in patients with chronic obstructive pulmonary disease in stationary phase [J]. China Medical Herald, 2012, 9(25):98-99.
[13] 杨培文,王群,利桂河,等.阿托伐他汀治疗稳定期重度COPD的临床研究[J].临床肺科杂志, 2012, 17(6):1041-1042. YANG Peiwen, WANG Qun, LI Guihe, et al. Clinical research about the atovastatin treatment effect on stable stage of severe chronic obstructive pulmonary disease[J]. Journal of Clinical Pulmonary Medicine, 2012, 17(6):1041-1042.
[14] 张艳.辛伐他汀在COPD治疗中的临床应用研究[J].中外健康文摘, 2011, 8(47):250-251.
[15] Marzilli M. Pleiotropic Effects of Statins: evidence for benefits beyond LDL-Cholesterol lowering [J]. Am J Cardiovasc Drugs, 2010, 10(Suppl 1):3-9.
[16] Alexeeff SE, Litonjua AA, Sparrow D, et al. Statin use reduces decline in lung function:VA Normative Aging Study [J]. Am J Respir Crit Care Med, 2007, 176(8):742-747.
[17] Bando M, Miyazawa T, Shinohara H, et al. An epidemiological study of the effects of statin use on airflow limitation in patients with chronic obstructive pulmonary disease [J]. Respirology, 2012, 17(3):493-498.
[18] Blamoun AI, Batty GN, DeBari VA, et al. Statins may reduce episodes of exacerbation and the requirement for intubation in patients with COPD:evidence from a retrospective cohort study [J]. Int J Clin Pract, 2008, 62(9):1373-1378.
[19] Frost FJ, Petersen H, Tollestrup K, et al. Influenza and COPD mortality protection as pleiotropic, dose-dependent effects of statins[J]. Chest, 2007, 131(4):1006-1012.
[20] Wang MT, Lo YW, Tsai CL, et al. Statin use and risk of COPD exacerbation requiring hospitalization [J]. Am J Med, 2013, 126(7):598-606.
[21] Mancini GB, Etminan M, Zhang B, et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease [J]. J Am Coll Cardiol, 2006, 47(12):2554-2560.
[22] Lahousse L, Loth DW, Joos GF, et al. Statins, systemic inflammation and risk of death in COPD:the Rotterdam study [J]. Pulm Pharmacol Ther, 2013, 26(2):212-217.
[23] 陈旭东,王伟,王永彬.辛伐他汀对COPD大鼠模型炎症的干预作用[J].山东大学学报:医学版, 2010, 48(4):36-39. CHEN Xudong, WANG Wei, WANG Yongbin. Effect of simvastatin on inflammation in chronic obstructive pulmonary disease rat model [J]. Journal of Shandong University: Health Sciences, 2010, 48(4):36-39.

相关文章 15

[1]	徐宁宇王磊郝恩魁苏国海. STEMI患者急诊PCI前口服阿托伐他汀对炎症介质及左心室功能的影响[J]. 山东大学学报(医学版), 2209, 47(6): 69-72.
[2]	高秀蕊臧恒昌. 复方烟酸辛伐他汀双层片体外释放度的研究[J]. 山东大学学报(医学版), 2209, 47(6): 109-113.
[3]	温学龙,刘安慧,陈经纬,吴梦婷,杨岷. 急性非ST抬高型心肌梗死行冠状动脉旁路移植手术时机Meta分析[J]. 山东大学学报 (医学版), 2025, 63(5): 60-70.
[4]	刘向荣,张新胜,杨荩冉,杨雪艳,刘钊,刘英华. ω-6/ω-3多不饱和脂肪酸比值对不同肿瘤发病风险的系统综述和Meta分析[J]. 山东大学学报 (医学版), 2024, 62(8): 34-48.
[5]	吴彤,杨晶玉,林盪,徐婉茹,曾宇鋆. 基于孟德尔随机化方法探讨脂质和降脂药物与慢性阻塞性肺病的遗传关联[J]. 山东大学学报 (医学版), 2024, 62(5): 54-63.
[6]	秦静,杨飞,陈谦,夏涵岱,刘延国,王秀问. 晚期驱动基因阴性、PD-L1表达阴性非鳞非小细胞肺癌一线治疗方案的网状Meta分析[J]. 山东大学学报 (医学版), 2022, 60(7): 74-82.
[7]	姚宇,王文军,梁玉灵. 他汀类药物对70例肺栓塞患者预后的影响[J]. 山东大学学报 (医学版), 2020, 58(11): 76-80.
[8]	洪树坤,田勇刚,李亚红,乔鲁军. 头罩与面罩无创通气对呼吸衰竭患者临床疗效的Meta分析[J]. 山东大学学报 (医学版), 2019, 57(7): 92-101.
[9]	陈红艳,马园园,孙虎魁. 肺癌患者¹⁸F-FDG PET/CT SUVmax与程序性死亡受体-配体1表达相关性的Meta分析[J]. 山东大学学报 (医学版), 2019, 57(6): 81-86.
[10]	殷晓霖,杨孝荣,张同超,满金宇,吕明. 儿茶酚氧位甲基转移酶基因G1947A多态性与吸烟行为相关性的Meta分析[J]. 山东大学学报 (医学版), 2019, 57(2): 110-116.
[11]	王海霞,李一章,白晨晓,姜迪,王丽雯,陈欧. 克拉霉素辅助治疗哮喘疗效及安全性的Meta分析[J]. 山东大学学报 (医学版), 2019, 57(11): 27-33.
[12]	齐萌,黄燕,吴珊珊,刘波,张思伟. 单能量去金属伪影算法重建效果的系统评价及Meta分析[J]. 山东大学学报 (医学版), 2018, 56(9): 59-64.
[13]	何鹏娟,颜磊,范明君,刘祥斌,赵兴波. 辛伐他汀对TGF-β诱导的卵巢癌上皮间质转化的影响[J]. 山东大学学报 (医学版), 2018, 56(5): 46-51.
[14]	倪迎春,杨孝荣,杜金阁,吕明. 豆制品摄入量与胃癌发病风险关系的Meta分析[J]. 山东大学学报 (医学版), 2018, 56(10): 93-102.
[15]	林萍珍,薛娇美,杨蓓,李萌,周麦琳,曹枫林. 基于Pearson相关系数的癌症患者创伤后成长与心理适应相关性的Meta分析[J]. 山东大学学报（医学版）, 2017, 55(9): 110-121.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed