他汀类药物以目标低密度脂蛋白胆固醇（LDL-c）水平和LDL-c降低依赖性方式恶化2型糖尿病（T2DM）的血糖控制：一项荟萃分析。
Statins worsen glycemic control of T2DM in target LDL-c level and LDL-c reduction dependent manners: a meta-analysis.
作者信息
Cai Rongrong, Yuan Yang, Sun Jie, Xia Wenqing, Huang Rong, Tian Sai, Dong Xue, Shen Yanjue, Wang Shaohua
机构信息
a Department of Endocrinology , The Affiliated ZhongDa Hospital of Southeast University , Nanjing , PR China.
b Medical School of Southeast University , Nanjing , PR China.
出版信息
Expert Opin Pharmacother. 2016 Oct;17(14):1839-49. doi: 10.1080/14656566.2016.1220539. Epub 2016 Aug 12.
OBJECTIVE
Recent studies demonstrated that a low target low-density lipoprotein cholesterol (LDL-c) level, high LDL-c reduction and high dose of statin therapy increased incident diabetes. This study aimed to explore how statin therapy influences glycemic control in type 2 diabetes mellitus (T2DM).
METHODS
Medline, Embase, and Cochrane Central were searched for randomized control trials inT2DM. Trials with target LDL-c levels of ≤2.6 mmol/L or LDL-c reduction of ≥30% were analyzed. Then, we calculated mean differences in glycosylated hemoglobin (HbA1c) and fasting blood glucose via stratified LDL-c level, relative LDL-c reduction and statin dose.
RESULTS
In total, trials involving 6,875 participants (3,619 statins, 3,256 controls) were included. Meta-analysis showed that detrimental effect of intensive LDL-c lowering statin therapy on HbA1c (SMD 0.10%; 95% CI 0.05, 0.15; p = 0.000) was more severe than all statin trials analyzed together (SMD 0.07%; 95% CI 0.02, 0.12; p = 0.005). Stratified analyses revealed that the effects on HbA1c became increasingly significant as target LDL-c level decreased and LDL-c reduction increased. Low baseline LDL-c and endpoint LDL-c levels were risk factors involved in increasing HbA1c level during statin therapy.
CONCLUSIONS
Statin therapy worsens the glycemic control of T2DM in target LDL-c level and LDL-c reduction dependent manners.
目的
近期研究表明，低目标低密度脂蛋白胆固醇（LDL-c）水平、高LDL-c降低幅度和高剂量他汀类药物治疗会增加糖尿病发病率。本研究旨在探讨他汀类药物治疗如何影响2型糖尿病（T2DM）患者的血糖控制。
方法
检索Medline、Embase和Cochrane Central数据库，查找T2DM的随机对照试验。分析目标LDL-c水平≤2.6 mmol/L或LDL-c降低幅度≥30%的试验。然后，我们通过分层LDL-c水平、相对LDL-c降低幅度和他汀类药物剂量计算糖化血红蛋白（HbA1c）和空腹血糖的平均差异。
结果
总共纳入了涉及6875名参与者的试验（3619名使用他汀类药物，3256名作为对照）。荟萃分析表明，强化降低LDL-c的他汀类药物治疗对HbA1c的有害影响（标准化均数差0.10%；95%置信区间0.05，0.15；p = 0.000）比所有一起分析的他汀类药物试验更严重（标准化均数差0.07%；95%置信区间0.02，0.12；p = 0.005）。分层分析显示，随着目标LDL-c水平降低和LDL-c降低幅度增加，对HbA1c的影响变得越来越显著。低基线LDL-c和终点LDL-c水平是他汀类药物治疗期间HbA1c水平升高的危险因素。
结论
他汀类药物治疗以目标LDL-c水平和LDL-c降低幅度依赖的方式恶化T2DM患者的血糖控制。
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