Thomson Neil C
Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 OYN, United Kingdom.
Curr Mol Pharmacol. 2017;10(1):60-71. doi: 10.2174/1874467209666160112125911.
Immunomodulatory effects of statins in vitro and in experimental models of asthma and COPD could potentially be relevant to the treatment of chronic airway diseases. This article provides an overview of the evidence from the key clinical studies on the effects of statins on clinical outcomes and inflammatory biomarkers in asthma and COPD. Future directions for clinical studies of statins in asthma and COPD are discussed. A small number of randomized controlled trials (RCTs) in adults with mild to moderate asthma suggest that short-term statin treatment does not improve lung function or symptom control, except for a possible improvement in quality of life and symptoms in smokers with asthma. Several observation studies report that statin use in asthma is associated with a reduced risk of asthma-related emergency department visits, oral corticosteroid dispensing or hospital admissions. Statins treatment in asthma may have modest local anti-inflammatory effects in the airways. There is a need for a large RCT examining the effects of statins on reducing exacerbations, particularly in severe asthma. In COPD, observational studies suggest that statin use is associated with reduced morbidity and/or mortality, whereas a large RCT concluded that simvastatin did not reduce exacerbations in patients with COPD that had no cardiovascular indication for statin treatment. It is possible that a subgroup of COPD patients with cardiovascular indications for statins and/or systemic inflammation may obtain clinical benefit from statin treatment. Understanding the immunomodulatory effects of statins in asthma and COPD may lead to the development of novel targeted interventions.
他汀类药物在哮喘和慢性阻塞性肺疾病（COPD）的体外及实验模型中的免疫调节作用可能与慢性气道疾病的治疗相关。本文概述了关于他汀类药物对哮喘和COPD临床结局及炎症生物标志物影响的关键临床研究证据。还讨论了他汀类药物在哮喘和COPD临床研究的未来方向。少数针对轻度至中度哮喘成人患者的随机对照试验（RCT）表明，短期他汀类药物治疗并不能改善肺功能或症状控制，但可能改善哮喘吸烟者的生活质量和症状。多项观察性研究报告称，哮喘患者使用他汀类药物与哮喘相关急诊就诊、口服糖皮质激素处方或住院风险降低有关。哮喘中的他汀类药物治疗可能对气道有适度的局部抗炎作用。需要进行一项大型RCT来研究他汀类药物对减少病情加重的影响，尤其是在重度哮喘中。在COPD中，观察性研究表明，使用他汀类药物与发病率和/或死亡率降低有关，而一项大型RCT得出结论，辛伐他汀并不能降低无他汀类药物治疗心血管指征的COPD患者的病情加重。可能有一部分有他汀类药物心血管指征和/或全身炎症的COPD患者可能从他汀类药物治疗中获得临床益处。了解他汀类药物在哮喘和COPD中的免疫调节作用可能会促成新型靶向干预措施的开发。
