他汀类药物治疗对痴呆风险、认知变化及其病理改变的影响概述：一项系统评价和荟萃分析
Overview the effect of statin therapy on dementia risk, cognitive changes and its pathologic change: a systematic review and meta-analysis.
作者信息
Zhu Xi-Chen, Dai Wen-Zhuo, Ma Tao
机构信息
Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China.
出版信息
Ann Transl Med. 2018 Nov;6(22):435. doi: 10.21037/atm.2018.06.43.
BACKGROUND
Many studies have reported on the role of statin therapy in dementia, but its efficacy remains controversial. We aimed to search for reliable and meaningful articles to assess the efficacy of statin therapy for dementia risk, cognitive items, and pathologic markers.
METHODS
Related literature for this study was published in the period from January 1, 1987 to January 1, 2018. Odds ratio (OR) and 95% confidence interval (95% CI) estimates were pooled in either fixed or random effects models.
RESULTS
A total of 23 relevant studies were included after the application of the search strategy. The pooled results showed that statin therapy would downregulate dementia risk according to an analysis of 1,314,431 dementia patients and 1,836,539 healthy controls (OR: 0.64, 95% CI: 0.50, 0.81). In addition, specific changes in mini-mental state examination (MMSE) score were observed in individuals with dementia with statin therapy (OR: 0.46, 95% CI: 0.17, 0.74). However, the results of this meta-analysis showed that statin therapy did not significantly modify the Alzheimer's Disease Assessment Scale (ADAS-cog) score (OR: -0.26, 95% CI: -1.13, 0.62). No significant association was found between statin therapy and activities of daily living performance (OR: -0.69, 95% CI: -4.12, 2.74). When investigating pathological markers, our results indicated a significant influence of statin therapy on plasma amyloid β (Aβ) (OR: 9.27, 95% CI: 0.71, 17.84), plasma Aβ (OR: 2.60, 95% CI: 1.07, 4.13), plasma low-density lipoprotein (LDL) cholesterol (OR: -16.95, 95% CI: -25.54, -8.37), plasma lathosterol (OR: -0.11, 95% CI: -0.14, -0.07), plasma 24s-hydroxycholesterol (OR: -10.41, 95% CI: -15.57, -5.25), and cerebrospinal fluid (CSF) lathosterol (OR: -0.07, 95% CI: -0.12, -0.01).
CONCLUSIONS
The available data indicate that statin therapy may reduce dementia risk, altering cognitive items and pathologic markers.
背景
许多研究报告了他汀类药物治疗在痴呆症中的作用，但其疗效仍存在争议。我们旨在寻找可靠且有意义的文章，以评估他汀类药物治疗对痴呆风险、认知指标和病理标志物的疗效。
方法
本研究的相关文献发表于1987年1月1日至2018年1月1日期间。比值比（OR）和95%置信区间（95%CI）估计值采用固定效应模型或随机效应模型进行汇总。
结果
应用检索策略后，共纳入23项相关研究。汇总结果显示，根据对1314431例痴呆患者和1836539例健康对照的分析，他汀类药物治疗可降低痴呆风险（OR：0.64，95%CI：0.50，0.81）。此外，接受他汀类药物治疗的痴呆患者的简易精神状态检查表（MMSE）评分有特定变化（OR：0.46，95%CI：0.17，0.74）。然而，这项荟萃分析的结果显示，他汀类药物治疗并未显著改变阿尔茨海默病评估量表（ADAS-cog）评分（OR：-0.26，95%CI：-1.13，0.62）。未发现他汀类药物治疗与日常生活能力表现之间存在显著关联（OR：-0.69，95%CI：-4.12，2.74）。在研究病理标志物时，我们的结果表明他汀类药物治疗对血浆淀粉样蛋白β（Aβ）（OR：9.27，95%CI：0.71，17.84）、血浆Aβ（OR：2.60，95%CI：1.07，4.13）、血浆低密度脂蛋白（LDL）胆固醇（OR：-16.95，95%CI：-25.54，-8.37）、血浆羊毛甾醇（OR：-0.11，95%CI：-0.14，-0.07）、血浆24s-羟基胆固醇（OR：-10.41，95%CI：-15.57，-5.25）和脑脊液（CSF）羊毛甾醇（OR：-0.07，95%CI：-0.12，-0.01）有显著影响。
结论
现有数据表明，他汀类药物治疗可能降低痴呆风险，改变认知指标和病理标志物。
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