Chen Mingqi, Lu Jun, Chen Qiuhua, Cheng Lu, Geng Yanxia, Jiang Hua, Wang Xing
Department of Critical Care Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, Jiangsu, China. Corresponding author: Lu Jun, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Jan;29(1):51-56. doi: 10.3760/cma.j.issn.2095-4352.2017.01.011.
To confirm the effects of statin therapy on mortality of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS).
PubMed/Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched for articles using the terms "acute lung injury", "ALI", "acute respiratory distress syndrome", "ARDS", "statin", "simvastatin" and "rosuvastatin" updated to November 17, 2015. Randomized controlled trial (RCT) or observational cohort studies investigating the effects of statin therapy on mortality in patients with ALI or ARDS were all identified, without date or language restriction. The control group was given conventional treatment, while the experimental group was treated with statins additionally. The primary outcome was in-hospital mortality. Meanwhile, ventilator-free day, intensive care unit (ICU)-free day, ICU length of stay (LOS) and ICU mortality were also analyzed. RevMan 5.2 and STATA 13 software were used for systematic review and Meta analysis, and funnel plot was used to analyze the publication bias.
A total of five trials including three randomized controlled trials and two observational studies were included. Among 1 636 patients enrolled in the study, there were 739 patients in experimental group, and 897 in control group. It was shown by Meta analysis that there was no significant difference in in-hospital mortality between experimental group and control group [relative risk (RR) = 0.96, 95% confidence interval (95%CI) = 0.79-1.15, P = 0.63]. The subgroup analysis based on RCT and cohort study, or the subgroup analysis of different statins showed that there was no significant difference in in-hospital mortality between the experimental group and the control group (both P > 0.05). There were no significant differences in ventilator-free days [mean difference (MD) = 1.41, 95%CI = -0.32-3.13, P = 0.11], ICU-free days (MD = -0.23, 95%CI = -1.61-1.15, P = 0.75), ICU length of stay (MD = -1.03, 95%CI = -6.55-4.50, P = 0.72), or ICU mortality (RR = 0.88, 95%CI = 0.68-1.14, P = 0.33) between the experimental group and the control group. It was shown by funnel plot that there was no publication bias in in-hospital mortality.
The systematic review and meta-analysis suggests that statin may not be associated with a significant reduction in mortality, ventilator-free day, ICU-free day and ICU length of stay in patients with ALI/ARDS.
确认他汀类药物治疗对急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）患者死亡率的影响。
检索PubMed/Medline、Embase、Web of Science和Cochrane对照试验中心注册库，查找截至2015年11月17日使用“急性肺损伤”“ALI”“急性呼吸窘迫综合征”“ARDS”“他汀类药物”“辛伐他汀”和“瑞舒伐他汀”等检索词的文章。纳入所有调查他汀类药物治疗对ALI或ARDS患者死亡率影响的随机对照试验（RCT）或观察性队列研究，无日期或语言限制。对照组给予常规治疗，试验组额外给予他汀类药物治疗。主要结局为住院死亡率。同时，还分析了无呼吸机天数、无重症监护病房（ICU）天数、ICU住院时间（LOS）和ICU死亡率。使用RevMan 5.2和STATA 13软件进行系统评价和Meta分析，并使用漏斗图分析发表偏倚。
共纳入5项试验，包括3项随机对照试验和2项观察性研究。在纳入研究的1636例患者中，试验组739例，对照组897例。Meta分析显示，试验组和对照组的住院死亡率无显著差异[相对危险度（RR）=0.96，95%置信区间（95%CI）=0.79 - 1.15，P = 0.63]。基于RCT和队列研究的亚组分析，或不同他汀类药物的亚组分析均显示，试验组和对照组的住院死亡率无显著差异（均P>0.05）。试验组和对照组在无呼吸机天数[平均差（MD）=1.41，95%CI = - 0.32 - 3.13，P = 0.11]、无ICU天数（MD = - 0.23，95%CI = - 1.61 - 1.15，P = 0.75）、ICU住院时间（MD = - 1.03，95%CI = - 6.55 - 4.50，P = 0.72）或ICU死亡率（RR = 0.88，95%CI = 0.68 - 1.14，P = 0.33）方面无显著差异。漏斗图显示住院死亡率不存在发表偏倚。
系统评价和Meta分析表明，他汀类药物可能与降低ALI/ARDS患者的死亡率、无呼吸机天数、无ICU天数和ICU住院时间无关。
