Department of Respiratory Medicine, Ruikang Hospital Affiliated To Guangxi Traditional Chinese Medicine University, Nanning, Guangxi, China.
Eur Rev Med Pharmacol Sci. 2018 May;22(10):3190-3198. doi: 10.26355/eurrev_201805_15080.
Approximately 7.5% of patients admitted to Intensive Care Unit (ICU) of hospitals are likely diagnosed with acute lung injury (ALI) or acute respiratory distress syndrome (ALI/ARDS), and more than one-third of the affected patients die with this disease. Despite the improvement in patient care with the availability of mechanical ventilators, mortality among these patients is unabated. Even though many drugs proved effective in preclinical studies, none is efficacious clinically, and no pharmacological treatment is insight. Statins were reported to exert anti-inflammatory effects and it was suggested that these drugs may be useful in ALI/ARDS patients. However, the initial positive results with statins were not confirmed in later studies, raising doubts about their usefulness. In the present meta-analysis, we examined the efficacy of statins in ALI/ARDS patients.
Various databases were searched to identify both randomized clinical trials and cohort studies, where statin users were compared to non-statin users. To increase the strength of the analysis, cohort studies and random clinical trials were combined in the present analysis. RevMan software from the Cochrane Collaboration was used to a conduct meta-analysis.
Baseline characteristics indicated that APACHE-III score to be lower in statin users, suggesting some beneficial effects. However, mortality and severe sepsis were unchanged following statin treatment. But results also showed reduced SOFA score and increased number of ventilator-free days among statin users, indicating that statins are likely to have some beneficial effects.
Statin treatment of ALI/ARDS patients seems to improve health in terms of organ failure and also by lowering the need for ventilation. However, the sample size is too small to accurately assess the effects on mortality and sepsis and further investigations are needed.
大约 7.5%入住医院重症监护病房（ICU）的患者可能被诊断为急性肺损伤（ALI）或急性呼吸窘迫综合征（ALI/ARDS），超过三分之一的受影响患者死于这种疾病。尽管有机械呼吸机的可用性，提高了患者的护理水平，但这些患者的死亡率仍未降低。尽管许多药物在临床前研究中被证明是有效的，但在临床上没有一种是有效的，也没有药物治疗方法。他汀类药物被报道具有抗炎作用，有人认为这些药物在 ALI/ARDS 患者中可能有用。然而，他汀类药物的最初积极结果在后来的研究中并未得到证实，这让人对其有效性产生了怀疑。在本荟萃分析中，我们研究了他汀类药物在 ALI/ARDS 患者中的疗效。
我们检索了各种数据库，以确定随机临床试验和队列研究，比较了他汀类药物使用者和非他汀类药物使用者。为了增强分析的力度，本分析将队列研究和随机临床试验合并在一起。我们使用 Cochrane 协作组的 RevMan 软件进行荟萃分析。
基线特征表明，他汀类药物使用者的 APACHE-III 评分较低，这表明可能有一些有益的影响。然而，他汀类药物治疗并没有降低死亡率和严重脓毒症的发生率。但结果也显示他汀类药物使用者的 SOFA 评分降低，呼吸机使用天数增加，这表明他汀类药物可能有一些有益的影响。
他汀类药物治疗 ALI/ARDS 患者似乎可以改善器官衰竭的健康状况，也可以降低通气的需要。然而，样本量太小，无法准确评估对死亡率和脓毒症的影响，需要进一步的研究。
