Tianjin Hospital, No. 406 Jiefang South Rd, Hexi District, Tianjin 300211, China.
Tianjin Hospital, No. 406 Jiefang South Rd, Hexi District, Tianjin 300211, China.
Autoimmun Rev. 2018 Mar;17(3):215-225. doi: 10.1016/j.autrev.2017.10.013. Epub 2018 Jan 31.
Over the past several years, numerous studies investigated the anti-inflammatory effects of statin on patients with RA. However, the findings of the individual studies were often inconsistent or conflicting.
The Pubmed, Web of Science, Embase, Cochrane Library and CNKI literature databases were searched in order to identify randomized controlled clinical trials where the association between the anti-inflammatory effect of statin and RA was investigated. Two researchers performed data extraction from eligible independently. Quality parameters and risk of bias in the included studies were assessed according to Cochrane's guidelines. The pooled Standardized Mean Difference (SMD) with a 95%CI was used to assess the anti-inflammatory effect of statin in patients with RA.
Fifteen randomized controlled clinical, classified as "high quality" and with a relatively low risk of selection bias, were included in the meta-analysis. Of these, eight reported that there was no difference in the level of serum total lipids between the atorvastatin-treated and the conventional treatment group. However, the pooled analysis showed that atorvastatin could increase the level of serum amount of high-density lipoprotein (HDL) in RA patients by approximately x ± SD95% [HDL: SMD = 0.807, 95%CI = (0.187, 1.426), p = .011]. Meanwhile atorvastatin could reduce the level of serum low-density lipoprotein (LDL), total cholesterol (TC), and triglyceride (TG) in RA patient by x ± SD95% [LDL: SMD = -4.015, 95%CI = (-5.848, -2.183), p = .000; TC: SMD = -4.497, 95%CI = (-6.457, -2.537), p = .000; TG: SMD = -1.475, 95%CI = (-2.352, -0.599), p = .001]. Nine studies reported a change in C-Reactive Protein (CRP) after atorvastatin treatment, and the pooled analysis showed that atorvastatin decreased CRP in RA patients by x ± SD95% [SMD = -3.033, 95%CI = (-4.460, -1.606), p = .000]. Seven studies investigated the change of Erythrocyte Sedimentation Rate (ESR), and the pooled analysis showed that atorvastatin decreased ESR by x ± SD95% [SMD = -2.097, 95%CI = (-3.408, -0.786), p = .002]. Nine studies reported the improvement of disease activity score in RA patients after taking atorvastatin for 12 weeks, and the pooled analysis showed atorvastatin could decrease the DAS28 score in RA patients by x ± SD95% [SMD = -2.001, 95%CI = (-3.191, -0.811), p = .001].
Statins have a significant anti-inflammatory effect in RA patients. However, atorvastatin was superior to simvastatin both in terms of its anti-inflammatory and lipid-lowering activities.
在过去的几年中，许多研究调查了他汀类药物对类风湿关节炎（RA）患者的抗炎作用。然而，个体研究的结果往往不一致或相互矛盾。
检索 Pubmed、Web of Science、Embase、Cochrane 图书馆和中国知网（CNKI）文献数据库，以确定研究他汀类药物抗炎作用与 RA 之间关系的随机对照临床试验。两位研究人员独立进行数据提取。根据 Cochrane 指南评估纳入研究的质量参数和偏倚风险。使用标准化均数差（SMD）及其 95%置信区间（CI）来评估他汀类药物对 RA 患者的抗炎作用。
纳入了 15 项随机对照临床试验，这些研究被归类为“高质量”，且选择偏倚风险较低。其中 8 项研究报告阿托伐他汀治疗组和常规治疗组之间血清总脂质水平无差异。然而，汇总分析显示，阿托伐他汀可使 RA 患者血清高密度脂蛋白（HDL）水平升高约 x ± SD95%[HDL：SMD = 0.807，95%CI =（0.187，1.426），p = 0.011]。同时，阿托伐他汀可使 RA 患者血清低密度脂蛋白（LDL）、总胆固醇（TC）和甘油三酯（TG）水平降低 x ± SD95%[LDL：SMD = -4.015，95%CI =（-5.848，-2.183），p = 0.000；TC：SMD = -4.497，95%CI =（-6.457，-2.537），p = 0.000；TG：SMD = -1.475，95%CI =（-2.352，-0.599），p = 0.001]。9 项研究报告了阿托伐他汀治疗后 C 反应蛋白（CRP）的变化，汇总分析显示阿托伐他汀可使 RA 患者 CRP 降低 x ± SD95%[SMD = -3.033，95%CI =（-4.460，-1.606），p = 0.000]。7 项研究调查了红细胞沉降率（ESR）的变化，汇总分析显示阿托伐他汀可使 ESR 降低 x ± SD95%[SMD = -2.097，95%CI =（-3.408，-0.786），p = 0.002]。9 项研究报告了服用阿托伐他汀 12 周后 RA 患者的疾病活动评分改善情况，汇总分析显示阿托伐他汀可使 RA 患者的 DAS28 评分降低 x ± SD95%[SMD = -2.001，95%CI =（-3.191，-0.811），p = 0.001]。
他汀类药物对 RA 患者具有显著的抗炎作用。然而，阿托伐他汀在抗炎和降脂活性方面均优于辛伐他汀。
