Singh Tejas P, Skalina Tristan, Nour Daniel, Murali Aarya, Morrison Sean, Moxon Joseph V, Golledge Jonathan
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.
The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
BMC Cardiovasc Disord. 2018 Jul 11;18(1):143. doi: 10.1186/s12872-018-0881-6.
The xanthine oxidase inhibitor allopurinol that is commonly used to treat gout, has been suggested to have pleiotropic effects that are likely to reduce the incidence of myocardial infarction (MI) in at risk individuals. The aim of this meta-analysis was to assess the efficacy of allopurinol treatment in reducing the incidence of MI.
MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched for randomised controlled trials examining the efficacy of allopurinol in reducing the incidence of MI. The quality of study methodology was assessed by two independent reviewers using the Cochrane Collaboration's tool for assessing risk of bias. This meta-analysis was conducted using a fixed-effects model, and heterogeneity was assessed with the I index.
One thousand one hundred twenty-three citations were screened and only six studies satisfied the inclusion criterion. Published between 1988 and 1995, all studies examined the cardioprotective efficacy of allopurinol in the setting of coronary artery bypass graft (CABG). From a total pooled sample size of 229, MI was reported in 2 (1.77%) allopurinol and 14 (12.07%) control patients. A fixed-effects meta-analysis (I = 0%) identified a statistically significant reduced incidence of myocardial infarction (RR 0.21, 95% CI: 0.06, 0.70, p = 0.01) in patients allocated to allopurinol. However, in the leave-one-out sensitivity analyses, the treatment effect became non-significant with the removal of one of the studies.
Based on the limited evidence available, allopurinol appears to reduce the incidence of perioperative MI following CABG. Further research is required to confirm these findings.
常用于治疗痛风的黄嘌呤氧化酶抑制剂别嘌醇，被认为具有多种效应，可能降低高危个体心肌梗死（MI）的发生率。本荟萃分析的目的是评估别嘌醇治疗在降低MI发生率方面的疗效。
检索MEDLINE、Scopus、科学引文索引和考克兰图书馆数据库，查找关于别嘌醇降低MI发生率疗效的随机对照试验。由两名独立评审员使用考克兰协作网的偏倚风险评估工具对研究方法的质量进行评估。本荟萃分析采用固定效应模型进行，并用I指数评估异质性。
筛选了1123篇文献，只有6项研究符合纳入标准。所有研究均发表于1988年至1995年之间，研究了别嘌醇在冠状动脉旁路移植术（CABG）中的心脏保护疗效。在总共229例的汇总样本量中，别嘌醇组有2例（1.77%）发生MI，对照组有14例（12.07%）发生MI。固定效应荟萃分析（I = 0%）表明，接受别嘌醇治疗的患者心肌梗死发生率显著降低（RR 0.21，95% CI：0.06，0.70，p = 0.01）。然而，在逐一剔除敏感性分析中，剔除其中一项研究后，治疗效果变得不显著。
基于现有有限证据，别嘌醇似乎可降低CABG术后围手术期MI的发生率。需要进一步研究来证实这些发现。
