Sandhu Sabrina, Wiebe Natasha, Fried Linda F, Tonelli Marcello
Department of Medicine, University of Alberta, Edmonton, Alberta T6B 2B7, Canada.
J Am Soc Nephrol. 2006 Jul;17(7):2006-16. doi: 10.1681/ASN.2006010012. Epub 2006 Jun 8.
Statins frequently are used to prevent cardiovascular events. Several recent studies suggest that statins also may have renal benefits, although this is controversial. This systematic review and meta-analysis were performed to assess the effect of statins on change in kidney function and urinary protein excretion. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, conference proceedings, and the authors' personal files were searched. Published or unpublished randomized, controlled trials or crossover trials of statins that reported assessment of kidney function or proteinuria were included, and studies of individuals with ESRD were excluded. Data were extracted for study design, subject characteristics, type of statin and dose, baseline/change in cholesterol levels, and outcomes (change in measured or estimated GFR [eGFR] and/or urinary protein excretion). Weighted mean differences were calculated for the change in GFR between statin and control groups using a random-effects model. A random-effects model also was used to calculate the standardized mean difference for the change in urinary protein excretion between groups. Twenty-seven eligible studies with 39,704 participants (21 with data for eGFR and 20 for proteinuria or albuminuria) were identified. Overall, the change in the weighted mean differences for eGFR was statistically significant (1.22 ml/min per yr slower in statin recipients; 95% confidence interval [CI] 0.44 to 2.00). In subgroup analysis, the benefit of statin therapy was statistically significant in studies of participants with cardiovascular disease (0.93 ml/min per yr slower than control subjects; 95% CI 0.10 to 1.76) but was NS for studies of participants with diabetic or hypertensive kidney disease or glomerulonephritis. The standardized mean difference for the reduction in albuminuria or proteinuria as a result of statin therapy was statistically significant (0.58 units of SD greater in statin recipients; 95% CI 0.17 to 0.98). Statin therapy seems to reduce proteinuria modestly and results in a small reduction in the rate of kidney function loss, especially in populations with cardiovascular disease.
他汀类药物常用于预防心血管事件。最近的几项研究表明，他汀类药物可能对肾脏也有益处，尽管这存在争议。进行这项系统评价和荟萃分析是为了评估他汀类药物对肾功能变化和尿蛋白排泄的影响。检索了医学期刊数据库（Medline）、荷兰医学文摘数据库（EMBASE）、Cochrane对照试验中心注册库、会议论文集以及作者的个人资料。纳入已发表或未发表的关于他汀类药物的随机对照试验或交叉试验，这些试验报告了对肾功能或蛋白尿的评估，排除了终末期肾病患者的研究。提取的数据包括研究设计、受试者特征、他汀类药物类型和剂量、胆固醇水平的基线/变化情况以及结局指标（实测或估算的肾小球滤过率[eGFR]变化和/或尿蛋白排泄）。使用随机效应模型计算他汀类药物组和对照组之间肾小球滤过率变化的加权平均差。还使用随机效应模型计算两组之间尿蛋白排泄变化的标准化平均差。确定了27项符合条件的研究，共39704名参与者（21项有eGFR数据，20项有蛋白尿或白蛋白尿数据）。总体而言，eGFR加权平均差的变化具有统计学意义（他汀类药物使用者每年慢1.22 ml/min；95%置信区间[CI]为0.44至2.00）。在亚组分析中，他汀类药物治疗的益处在心血管疾病参与者的研究中具有统计学意义（比对照组每年慢0.93 ml/min；95%CI为0.10至1.76），但在糖尿病或高血压肾病或肾小球肾炎参与者的研究中无统计学意义。他汀类药物治疗导致蛋白尿或白蛋白尿减少的标准化平均差具有统计学意义（他汀类药物使用者的标准差单位高0.58；95%CI为0.17至0.98）。他汀类药物治疗似乎能适度减少蛋白尿，并使肾功能丧失率略有降低，尤其是在心血管疾病人群中。
