Tariq Raseen, Mukhija Dhruvika, Gupta Arjun, Singh Siddharth, Pardi Darrell S, Khanna Sahil
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Department of Internal Medicine, Rochester General Hospital, Rochester, NY.
Infect Drug Resist. 2018 Mar 13;11:405-416. doi: 10.2147/IDR.S156475. eCollection 2018.
Statins have pleiotropic effects beyond cholesterol lowering by immune modulation. The association of statins with primary infection (CDI) is unclear as studies have reported conflicting findings. We performed a systematic review and meta-analysis to evaluate the association between statin use and CDI.
We searched MEDLINE, Embase, and Web of Science from January 1978 to December 2016 for studies assessing the association between statin use and CDI. The Newcastle-Ottawa Scale was used to assess the methodologic quality of included studies. Weighted summary estimates were calculated using generalized inverse variance with random-effects model.
Eight studies (6 case-control and 2 cohort) were included in the meta-analysis, which comprised 156,722 patients exposed to statins and 356,185 controls, with 34,849 total cases of CDI available in 7 studies. The rate of CDI in patients with statin use was 4.3%, compared with 7.8% in patients without statin use. An overall meta-analysis of 8 studies using the random-effects model demonstrated that statins may be associated with a decreased risk of CDI (maximally adjusted odds ratio [OR], 0.80; 95% CI, 0.66-0.97; =0.02). There was significant heterogeneity among the studies, with an of 79%. No publication bias was seen. Meta-analysis of studies that adjusted for confounders revealed no protective effect of statins (adjusted OR, 0.84; 95% CI, 0.70-1.01; =0.06, =75%). However, a meta-analysis of only full-text studies using the random-effects model demonstrated a decreased risk of CDI with the use of statins (OR 0.77; 95% CI, 0.61-0.99; =0.04, =85%).
Meta-analyses of existing studies suggest that patients prescribed a statin may be at decreased risk for CDI. The results must be interpreted with caution given the significant heterogeneity and lack of benefit on analysis of studies that adjusted for confounders.
他汀类药物除了通过免疫调节降低胆固醇外，还具有多效性作用。由于研究报告的结果相互矛盾，他汀类药物与艰难梭菌感染（CDI）之间的关联尚不清楚。我们进行了一项系统评价和荟萃分析，以评估他汀类药物使用与CDI之间的关联。
我们检索了1978年1月至2016年12月期间的MEDLINE、Embase和科学网，以查找评估他汀类药物使用与CDI之间关联的研究。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。采用随机效应模型的广义逆方差计算加权汇总估计值。
荟萃分析纳入了8项研究（6项病例对照研究和2项队列研究），共包括156,722名使用他汀类药物的患者和356,185名对照，7项研究中共有34,849例CDI病例。使用他汀类药物的患者中CDI发生率为4.3%，未使用他汀类药物的患者中为7.8%。采用随机效应模型对8项研究进行的总体荟萃分析表明，他汀类药物可能与CDI风险降低有关（最大调整比值比[OR]为0.80；95%可信区间为0.66-0.97；P=0.02）。研究之间存在显著异质性，I²为79%。未发现发表偏倚。对调整了混杂因素的研究进行的荟萃分析显示，他汀类药物没有保护作用（调整后OR为0.84；95%可信区间为0.70-1.01；P=0.06，I²=75%）。然而，仅对全文研究采用随机效应模型进行的荟萃分析表明，使用他汀类药物可降低CDI风险（OR为0.77；95%可信区间为0.61-0.99；P=0.04，I²=85%）。
现有研究的荟萃分析表明，开具他汀类药物处方的患者发生CDI的风险可能降低。鉴于显著的异质性以及对调整了混杂因素的研究分析缺乏益处，对结果的解释必须谨慎。
