Wang Shao-Ting, Sun Xue-Feng
Department of Respiratory Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018 Feb 28;40(1):30-40. doi: 10.3881/j.issn.1000-503X.2018.01.006.
Objective To systemically evaluate the the role of statins in prevention and treatment of community-acquired pneumonia (CAP). Methods A computer-based searching was conducted in PubMed,EMbase,Cochrane Library,Wanfang,and CNKI database up to October 2016. Totally 21 eligible articles were retrieved. According to the Cochrane Handbook 5.0 or Newcastle-Ottawa Scale (NOS) quality evaluation criteria,two independent reviewers carried out literature screening,data retraction,and quality evaluation. Meta-analysis was conducted with RevMan 5.3 software. Results A total 1 007 765 CAP patients from 12 studies were divided into two groups:statin group (n=118 096) and non-statin group (n=889 669). Meta-analysis suggested that statin use was associated with decreased mortality of CAP (OR=0.67,95%CI:0.57-0.79). We further divided the studies into North America group and Europe group and found the heterogenicity of North America group was lower than that of Europe group,and the Meta-analysis of both group supported the association of statin use with decreased CAP mortality (OR=0.66,95%CI:0.62-0.67;OR=0.71,95%CI:0.55-0.92). To identify the effect of statin use on mechanical ventilation,we included three articles (n=123 645) for further analysis (statin group,n=23 796;non-statin group,n=99 849),and Meta-analysis suggested that statin use was associated with decreased requirement for mechanical ventilation (OR=0.74,95%CI:0.70-0.78). Four articles (n=127 060) were enrolled (statin group,n=24 121 and non-statin group,n=102 939) to analyze the effect of statin use on ICU admission,and Meta-analysis suggested that statin use was associated with decreased requirement for ICU admission (OR=0.85,95%CI:0.82-0.88). Eleven articles (n=2 124 849) (statin group,n=306 108;non-statin group,n=1 818 741) to evaluate the effect of statin use on risk of CAP,and Meta-analysis suggested that long-term use of statins decreased the risk of CAP,although there was no statistical difference (OR=0.85,95%CI:0.85-1.07); the above studies were divided into case-control studies and cohort studies,and the case-control studies revealed statins increased the risk of CAP (OR=1.12,95%CI:1.03-1.21),while the cohort studies supported the association of statin use with decreased CAP risk (OR=0.46,95%CI:0.44-0.49). Conclusions Statin use may decrease the CAP mortality and the requirement for mechanical ventilation or ICU admission. However,whether statin use can reduce the risk of pneumonia remains unclear.
目的 系统评价他汀类药物在社区获得性肺炎（CAP）防治中的作用。方法 检索截至2016年10月的PubMed、EMbase、Cochrane图书馆、万方和中国知网数据库。共检索到21篇符合条件的文章。根据Cochrane手册5.0或纽卡斯尔-渥太华量表（NOS）质量评价标准，由两名独立评价者进行文献筛选、数据提取和质量评价。采用RevMan 5.3软件进行Meta分析。结果 12项研究中总共1 007 765例CAP患者被分为两组：他汀类药物组（n = 118 096）和非他汀类药物组（n = 889 669）。Meta分析表明，使用他汀类药物与CAP死亡率降低相关（OR = 0.67，95%CI：0.57 - 0.79）。我们进一步将研究分为北美组和欧洲组，发现北美组的异质性低于欧洲组，两组的Meta分析均支持使用他汀类药物与CAP死亡率降低相关（OR = 0.66，95%CI：0.62 - 0.67；OR = 0.71，95%CI：0.55 - 0.92）。为确定使用他汀类药物对机械通气的影响，纳入3篇文章（n = 123 645）进行进一步分析（他汀类药物组，n = 23 796；非他汀类药物组，n = 99 849），Meta分析表明，使用他汀类药物与机械通气需求降低相关（OR = 0.74，95%CI：0.70 - 0.78）。纳入4篇文章（n = 127 060）（他汀类药物组，n = 24 121；非他汀类药物组，n = 102 939）分析使用他汀类药物对入住重症监护病房（ICU）的影响，Meta分析表明，使用他汀类药物与入住ICU需求降低相关（OR = 0.85，95%CI：0.82 - 0.88）。纳入11篇文章（n = 2 124 849）（他汀类药物组，n = 306 108；非他汀类药物组，n = 1 818 741）评估使用他汀类药物对CAP风险的影响，Meta分析表明，长期使用他汀类药物可降低CAP风险，尽管无统计学差异（OR = 0.85，95%CI：0.85 - 1.07）；上述研究分为病例对照研究和队列研究，病例对照研究显示他汀类药物增加CAP风险（OR = 1.12，95%CI：1.03 - 1.21），而队列研究支持使用他汀类药物与降低CAP风险相关（OR = 0.46，95%CI：0.44 - 0.49）。结论 使用他汀类药物可能降低CAP死亡率以及机械通气或入住ICU的需求。然而，他汀类药物使用能否降低肺炎风险仍不明确。
