Gui Ya-Jun, Liao Cai-Xiu, Liu Qiong, Guo Yuan, Yang Tao, Chen Jing-Yuan, Wang Ya-Ting, Hu Jia-Hui, Xu Dan-Yan
1 Department of Cardiovascular Medicine, The Second Xiangya Hospital, China.
2 Department of Geratology, Third Hospital of Changsha, China.
Eur J Prev Cardiol. 2017 Jun;24(9):907-916. doi: 10.1177/2047487317691874. Epub 2017 Feb 13.
Background Statin treatment in association with physical exercise can substantially reduce mortality in dyslipidaemic individuals. However, the available data to compare the efficacy and safety of statins and exercise combination therapy with statin monotherapy are limited. Design Systematic review and meta-analysis. Methods We systematically searched PubMed, Embase and the Cochrane Library from database inception until December 2016. We included randomised and non-randomised studies that compared the efficacy and safety of statins and exercise combination therapy with statin monotherapy in patients with dyslipidaemia. Standardised mean differences were calculated and pooled by means of fixed effects models. The risk of bias and heterogeneity among trials was also assessed. Seven articles were assessed in terms of the efficacy of therapy and 13 from the viewpoint of therapeutic safety. Results In terms of efficacy, statins and exercise combination decreased the incidence of diabetes mellitus, improved insulin sensitivity and inflammation, but caused no change in lipid profile compared to statins alone. In terms of safety, statins and exercise combination increased peak oxygen uptake (standardised mean difference 1.01, 95% confidence interval 0.46 to 1.57) compared to statins alone. In contrast to statin-induced myopathy, chronic exercise training prior to statin treatment could counteract statin-induced adverse effects in skeletal muscle. Conclusion Statins and exercise combination therapy is more effective than statin monotherapy in terms of insulin sensitivity, inflammation and exercise capacity. The small number of studies warrants the need for more randomised controlled trials evaluating the efficacy and safety of combination therapy.
背景 他汀类药物治疗联合体育锻炼可显著降低血脂异常患者的死亡率。然而，比较他汀类药物与运动联合疗法和他汀类药物单药疗法的疗效和安全性的现有数据有限。
设计 系统评价和荟萃分析。
方法 我们从数据库建立至2016年12月，系统检索了PubMed、Embase和Cochrane图书馆。我们纳入了比较他汀类药物与运动联合疗法和他汀类药物单药疗法在血脂异常患者中的疗效和安全性的随机和非随机研究。计算标准化均数差，并通过固定效应模型进行汇总。还评估了试验之间的偏倚风险和异质性。从治疗效果方面评估了7篇文章，从治疗安全性角度评估了13篇文章。
结果 在疗效方面，与单独使用他汀类药物相比，他汀类药物与运动联合使用可降低糖尿病发病率，改善胰岛素敏感性和炎症，但对血脂谱无影响。在安全性方面，与单独使用他汀类药物相比，他汀类药物与运动联合使用可增加峰值摄氧量（标准化均数差1.01，95%置信区间0.46至1.57）。与他汀类药物引起的肌病相反，在他汀类药物治疗前进行慢性运动训练可抵消他汀类药物对骨骼肌的不良反应。
结论 在胰岛素敏感性、炎症和运动能力方面，他汀类药物与运动联合疗法比他汀类药物单药疗法更有效。研究数量较少，因此需要更多随机对照试验来评估联合疗法的疗效和安全性。
