Zhang Wen, Zhang Yi, Li Chuan-Wei, Jones Paul, Wang Chen, Fan Ye
Department of Respiratory Disease, Xinqiao Hospital, Chongqing, China.
Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China.
Chest. 2017 Dec;152(6):1159-1168. doi: 10.1016/j.chest.2017.08.015. Epub 2017 Aug 25.
Much controversy persists regarding the place of statin drugs in the treatment of patients with COPD. This systematic review and meta-analysis sought to determine the clinical efficacy of statin therapy in COPD.
We searched MEDLINE, EMBASE, the Cochrane Database, and PubMed for relevant clinical studies. Randomized controlled trials (RCTs) comparing the effects of statin drugs with placebo in COPD populations were included. Pooled estimates were calculated using a random-effects model. Heterogeneity was determined using the I statistic.
Ten trials with a total of 1,471 patients were included. Statin treatment was associated with a larger improvement in exercise capacity, lung function, and St. George's Respiratory Questionnaire score compared with placebo, but there were no statistically significant differences in inflammatory markers, all-cause mortality, and safety outcomes; however, subgroup analysis indicated that statin drugs improved clinical outcomes in the subjects from trials enrolling patients with overt cardiovascular disease (CVD), elevated baseline C-reactive protein levels, or a high cholesterol level.
The findings from this systematic review suggest a role for statin drugs in patients with COPD and coexisting CVD, evidence of increased systemic inflammation, or hyperlipidemia with respect to improving exercise tolerance and pulmonary function. These findings need to be confirmed by RCTs specifically designed to test this hypothesis and identify appropriate patients for statin use.
PROSPERO: CRD42017060594; https://www.crd.york.ac.uk/PROSPERO/.
关于他汀类药物在慢性阻塞性肺疾病（COPD）患者治疗中的地位，仍存在诸多争议。本系统评价和荟萃分析旨在确定他汀类药物治疗COPD的临床疗效。
我们检索了MEDLINE、EMBASE、Cochrane数据库和PubMed以查找相关临床研究。纳入比较他汀类药物与安慰剂对COPD人群影响的随机对照试验（RCT）。使用随机效应模型计算合并估计值。使用I统计量确定异质性。
纳入了10项试验，共1471例患者。与安慰剂相比，他汀类药物治疗与运动能力、肺功能和圣乔治呼吸问卷评分的更大改善相关，但在炎症标志物、全因死亡率和安全性结局方面无统计学显著差异；然而，亚组分析表明，在纳入明显心血管疾病（CVD）患者、基线C反应蛋白水平升高或胆固醇水平高的患者的试验中，他汀类药物改善了受试者的临床结局。
本系统评价的结果表明，他汀类药物在合并CVD、存在全身炎症增加证据或高脂血症的COPD患者中，在改善运动耐量和肺功能方面具有一定作用。这些发现需要通过专门设计以检验该假设并确定适合使用他汀类药物的患者的RCT来证实。
PROSPERO：CRD42017060594；https://www.crd.york.ac.uk/PROSPERO/ 。
