他汀类药物在慢性阻塞性肺疾病治疗中的作用的meta分析及系统评价

发布时间：2018-08-13 09:48

【摘要】：目的:以前的研究表明,慢性阻塞性肺疾病(COPD)的患者容易合并心血管事件,慢性阻塞性肺疾病患者合并心血管疾病预后较差,短期和长期生存率明显降低。一些观察性研究表明他汀类药物治疗可能降低慢性阻塞性肺疾病患者的死亡率。然而,其他一些研究未能得出类似的结论。因此,我们进行了一项系统评价和meta分析,以确定他汀类药物的使用是否影响COPD患者的结局。方法:我们检索了PubMed,Embase,Web of Science,The Cochrane Library、知网CNKI、中国生物医学文献数据库(CBM)等中英文数据库,检索关于他汀类药物治疗对COPD结局的影响的队列研究。主要结局指标是全因死亡率,次要结局指标是COPD死亡率,心血管相关死亡率,癌症死亡率,COPD急性加重。我们选择比值比及其95%置信区间作为合并效应量,并使用随机效应模型合并效应量。我们采用Egger检验来检测是否存在发表偏倚,还进行了敏感性分析及亚组分析。结果:最终我们纳入了19项队列研究,包括181,911例慢性阻塞性肺疾病患者,其中,13项队列研究(670,99例患者)报告了慢性阻塞性肺疾病患者应用他汀类药物后的全因死亡率,随机效应模型meta分析结果显示合并的OR值为0.67,95%置信区间为(0.61-0.75);共3个队列研究(13,549例患者)报告了慢性阻塞性肺疾病患者应用他汀类药物后的肿瘤相关死亡率,随机效应模型meta分析结果显示合并的OR值为0.61,95%置信区间为(0.50-0.75);共2个队列研究(77,919例患者)报告了慢性阻塞性肺疾病患者应用他汀类药物后的COPD死亡率,随机效应模型meta分析结果显示合并的OR值为0.42,95%置信区间为(0.23-0.78);共3个队列研究(4,425例患者)报告了慢性阻塞性肺疾病患者应用他汀类药物后的心血管事件死亡率,随机效应模型meta分析结果显示合并的OR值为0.55,95%置信区间为(0.34-0.90);共4个队列研究(32,294例患者)报告了慢性阻塞性肺疾病患者应用他汀类药物后的急性加重风险,随机效应模型meta分析结果显示合并的OR值为0.67,95%置信区间为(0.61-0.73)。结论:患有慢性阻塞性肺疾病的患者使用他汀类药物可能会降低全因死亡率,癌症死亡率,COPD死亡率,心血管死亡率,COPD恶化风险。他汀类药物的抗炎和免疫调节作用可能是这些关联的作用机制。此结论需要大型的、设计良好的随机对照实验来验证。
[Abstract]:Objective: previous studies have shown that patients with chronic obstructive pulmonary disease (COPD) are more likely to be associated with cardiovascular events, and patients with chronic obstructive pulmonary disease (COPD) have poorer prognosis and lower short-term and long-term survival rates. Some observational studies have shown that statins may reduce mortality in patients with chronic obstructive pulmonary disease. However, other studies have failed to reach similar conclusions. Therefore, we conducted a systematic review and meta analysis to determine whether statins affect outcomes in patients with COPD. Methods: a cohort study on the effect of statins on the outcome of COPD was conducted by retrieving the Chinese and English databases of PubMedus Embase of the Cochrane Library, CNKI, (CBM) and so on. The main outcome index was all-cause mortality, the secondary outcome index was COPD mortality, cardiovascular mortality, cancer mortality and acute exacerbation of COPD. We choose the ratio and its 95% confidence interval as the combination effect quantity, and use the random effect model to combine the effect quantity. We used Egger test to detect publication bias, sensitivity analysis and subgroup analysis. Results: in the end, we included 19 cohort studies, including 181911 patients with chronic obstructive pulmonary disease, of whom 13 cohort studies (67099 patients) reported the all-cause mortality of patients with chronic obstructive pulmonary disease treated with statins. Random effect model (meta) analysis showed that the OR value of the cohort was 0.67V 95% confidence interval (0.61-0.75). Three cohort studies (13549 patients) reported tumor-related mortality in patients with chronic obstructive pulmonary disease (COPD) treated with statins. Random effect model (meta) analysis showed that the combined OR value was 0.61V 95% confidence interval (0.50-0.75). Two cohort studies (77919 patients) reported the COPD mortality rate of patients with chronic obstructive pulmonary disease (COPD) treated with statins. The results of meta analysis of random effect model showed that the OR value of the cohort was 0.42 卤95% confidence interval (0.23-0.78). Three cohort studies (4425 patients) reported cardiovascular event mortality in patients with chronic obstructive pulmonary disease (COPD) treated with statins. Random effect model meta analysis showed that the combined OR value was 0.55V 95% confidence interval (0.34-0.90). Four cohort studies (32294 patients) reported the acute exacerbation risk of patients with chronic obstructive pulmonary disease (COPD) treated with statins. Meta analysis of stochastic effect model showed that the combined OR value was 0.6795% confidence interval (0.61-0.73). Conclusion: the use of statins in patients with chronic obstructive pulmonary disease may reduce the all-cause mortality, cancer mortality and COPD mortality, and cardiovascular mortality associated with the risk of exacerbation of COPD. The anti-inflammatory and immunomodulatory effects of statins may be the mechanisms of these associations. This conclusion needs to be verified by a large, well-designed randomized controlled trial.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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