Green Darren, Ritchie James P, Kalra Philip A
Vascular Research Group, Department of Renal Medicine, Salford Royal Hospital, Salford, UK.
Nephron Clin Pract. 2013;124(3-4):209-17. doi: 10.1159/000357676. Epub 2014 Jan 9.
BACKGROUND/AIMS: The use of lipid-lowering therapy (LLT) in patients on chronic dialysis is contentious. Here we present an aggregate data meta-analysis of randomised controlled trials (RCTs) comparing long-term LLT versus placebo in dialysis patients.
A search of Medline, Google Scholar, COCHRANE database, EMBASE, and cardiovascular and nephrology society proceedings was performed. Criteria for inclusion were RCTs of LLT versus placebo, in which LLT was demonstrated to significantly reduce low-density lipoprotein cholesterol, >12 months of follow-up, and at least one cardiovascular or mortality endpoint in an independently reported dialysis population. Meta-analysis was performed for atherosclerotic cardiovascular events, stroke and mortality using a random-effects method for odds ratio (OR) of risk.
Three studies were included with 7,051 patients (3,541 treatment and 3,510 placebo). Twenty-five percent of the LLT patients suffered an atherosclerotic cardiovascular event versus 27% for placebo. The OR was 0.89 (95% CI: 0.80-0.99, p = 0.04). For stroke (haemorrhagic and non-haemorrhagic combined), the figures were 6.2% (LLT) versus 5.7% (placebo) [OR = 1.11 (95% CI: 0.85-1.46, p = 0.45)]. For all-cause mortality, the figures were 40 versus 42% [OR = 0.97 (95% CI: 0.88-1.06, p = 0.49)].
There was an overall significant reduction in risk for atherosclerotic cardiovascular events in dialysis patients treated with LLT compared to placebo. There was a numerical but not a statistical reduction in mortality. There was no statistically significant increase in risk of stroke as has been previously reported.
背景/目的：在接受慢性透析的患者中使用降脂治疗（LLT）存在争议。在此，我们对比较透析患者长期LLT与安慰剂的随机对照试验（RCT）进行汇总数据荟萃分析。
检索了Medline、谷歌学术、Cochrane数据库、EMBASE以及心血管和肾脏病学会会议记录。纳入标准为LLT与安慰剂的RCT，其中LLT被证明能显著降低低密度脂蛋白胆固醇、随访时间>12个月，且在独立报告的透析人群中至少有一个心血管或死亡终点。采用随机效应方法对动脉粥样硬化性心血管事件、中风和死亡率进行风险比值比（OR）的荟萃分析。
纳入三项研究，共7051例患者（3541例接受治疗，3510例接受安慰剂）。25%接受LLT的患者发生动脉粥样硬化性心血管事件，而接受安慰剂的患者为27%。OR为0.89（95%CI：0.80 - 0.99，p = 0.04）。对于中风（出血性和非出血性合并），相应数字分别为6.2%（LLT）和5.7%（安慰剂）[OR = 1.11（95%CI：0.85 - 1.46，p = 0.45）]。对于全因死亡率，相应数字分别为40%和42%[OR = 0.97（95%CI：0.88 - 1.06，p = 0.49）]。
与安慰剂相比，接受LLT治疗的透析患者动脉粥样硬化性心血管事件风险总体显著降低。死亡率有数值上的降低，但无统计学意义。如先前报道，中风风险无统计学显著增加。
