Cheng H-H, Tang T-T, He Q, Huang L-J, Lin X-L, Chen M, Yang C, Geng D-F, Jiang S-P
Department of SICU, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Eur Rev Med Pharmacol Sci. 2014 Aug;18(16):2294-305.
There exist reports that statin treatment has beneficial effects for patients with pneumonia. The objective of this study was to evaluate whether the available published data support that statins as adjunctive therapy could reduce mortality associated with pneumonia and, thus, help to assess whether a randomized controlled study is warranted.
A meta-analysis of observational studies such as cohort studies and case-control studies identified in Pubmed, Scopus, EMBASE, the Cochrane Central Register of Controlled Trials and Clinicaltrials.gov. Eligible patients were adults with pneumonia. Studies that reported mortality of pneumonia grouped by statins usage were included. Data was analyzed and pooled using Revman 5.1.
Fourteen studies with 269,739 participants were included in this study. Pooled analysis showed that statin treatment was associated with lower 30-day mortality, with an OR of 0.44 (95% CI, 0.29-0.67), and an adjusted OR of 0.59 (95% CI 0.48-0.73, NNT30d = 19). Statin therapy was also associated with lower long-term (> 30 days) mortality, with an OR of 0.49 (95% CI, 0.29-0.84) and an adjusted OR of 0.65 (95% CI, 0.51-0.82, NNTlong-term = 15). For pneumonia inpatients, the raw data demonstrated no significant benefit from statin therapy (OR = 0.86, 95% CI, 0.56-1.34). Adjusted data showed a marginal benefit (adjusted OR = 0.89, 95% CI, 0.81-0.97, NNTinpatient = 230). Subgroup analysis revealed that current statin users might have better outcomes than recent or past statins users.
This meta-analysis supports that patients who happen to be receiving statin therapy have less mortality from pneumonia. However, it remains unclear whether initiation of statins at time of diagnosis is beneficial. There is only modest evidence to support the value of a well-designed randomized controlled clinical trial.
有报道称他汀类药物治疗对肺炎患者有有益作用。本研究的目的是评估现有已发表的数据是否支持他汀类药物作为辅助治疗可降低肺炎相关死亡率，从而有助于评估是否有必要进行一项随机对照研究。
对在PubMed、Scopus、EMBASE、Cochrane对照试验中央注册库和Clinicaltrials.gov中检索到的队列研究和病例对照研究等观察性研究进行荟萃分析。符合条件的患者为成年肺炎患者。纳入报告了按他汀类药物使用情况分组的肺炎死亡率的研究。使用Revman 5.1对数据进行分析和汇总。
本研究纳入了14项研究，共269,739名参与者。汇总分析显示，他汀类药物治疗与较低的30天死亡率相关，比值比（OR）为0.44（95%置信区间[CI]，0.29 - 0.67），调整后的OR为0.59（95% CI 0.48 - 0.73，30天内需要治疗的人数[NNT30d] = 19）。他汀类药物治疗还与较低的长期（> 30天）死亡率相关，OR为0.49（95% CI，0.29 - 0.84），调整后的OR为0.65（95% CI，0.51 - 0.82，长期需要治疗的人数[NNTlong - term] = 15）。对于肺炎住院患者，原始数据显示他汀类药物治疗无显著益处（OR = 0.86，95% CI，0.56 - 1.34）。调整后的数据显示有微弱益处（调整后的OR = 0.89，95% CI，0.81 - 0.97，住院患者需要治疗的人数[NNTinpatient] = 230）。亚组分析显示，当前使用他汀类药物的患者可能比近期或过去使用他汀类药物的患者有更好的结局。
这项荟萃分析支持碰巧接受他汀类药物治疗的患者肺炎死亡率较低。然而，在诊断时开始使用他汀类药物是否有益仍不清楚。仅有适度证据支持设计良好的随机对照临床试验的价值。
