Li Xiaofei, Sheng Lina, Lou Lanqing
Department of Infectious Diseases, Yiwu Central Hospital, Yiwu, China.
Front Med (Lausanne). 2020 Apr 24;7:121. doi: 10.3389/fmed.2020.00121. eCollection 2020.
Tuberculosis remains one of the leading causes of mortality among the infectious diseases, while statins were suggested to confer anti-infective efficacy in experimental studies. We aimed to evaluate the association between statin use and tuberculosis infection in a meta-analysis. Relevant studies were obtained via systematically search of PubMed and Embase databases. A random or a fixed effect model was applied to pool the results according to the heterogeneity among the included studies. Subgroup analyses according to the gender and diabetic status of the participants were performed. We assessed the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Nine observational studies were included. Significant heterogeneity was detected among the studies (p for Cochrane's Q test <0.001, = 93%). The GRADE approach showed generally low quality of evidence. Pooled results showed that statin use was associated with reduced active tuberculosis infection (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.45 to 0.75, < 0.001). Subgroup analyses showed that the negative association between statin use and active tuberculosis infection was consistent in men (RR: 0.63, = 0.01) and women (RR: 0.58, < 0.001), in participants with (RR: 0.63, = 0.02) and without diabetes (RR: 0.50, < 0.001), in retrospective cohort studies (RR: 0.56, = 0.02), prospective cohort studies (RR: 0.76, = 0.03), nested case-controls studies (RR: 0.57, < 0.001), and case-control studies (RR: 0.60, < 0.001), and in studies with statin used defined as any use within 1 year (RR: 0.59, < 0.001) or during follow-up (RR: 0.61, < 0.001). Significant publication bias was detected (p for Egger's regression test = 0.046). Subsequent "trim and fill" analyses retrieved an unpublished study to generate symmetrical funnel plots, and meta-analysis incorporating this study did not significantly affect the results (RR: 0.72, 95% CI: 0.68 to 0.76, < 0.001). Statin use may be associated with reduced active tuberculosis infection. Randomized controlled trials (RCTs) are needed to confirm the potential preventative role of statin use on tuberculosis infection.
结核病仍然是传染病中主要的致死原因之一，而在实验研究中他汀类药物被认为具有抗感染功效。我们旨在通过一项荟萃分析评估他汀类药物使用与结核感染之间的关联。通过系统检索PubMed和Embase数据库获取相关研究。根据纳入研究之间的异质性，应用随机或固定效应模型汇总结果。根据参与者的性别和糖尿病状态进行亚组分析。我们采用推荐分级评估、制定与评价（GRADE）方法评估证据质量。纳入了9项观察性研究。研究之间检测到显著异质性（Cochrane Q检验p<0.001，I² = 93%）。GRADE方法显示证据质量总体较低。汇总结果表明，使用他汀类药物与活动性结核感染减少相关（风险比[RR]：0.60，95%置信区间[CI]：0.45至0.75，p<0.001）。亚组分析表明，他汀类药物使用与活动性结核感染之间的负相关在男性（RR：0.63，p = 0.01）和女性（RR：0.58，p<0.001）、有糖尿病（RR：0.63，p = 0.02）和无糖尿病参与者（RR：0.50，p<0.001）、回顾性队列研究（RR：0.56，p = 0.02）、前瞻性队列研究（RR：0.76，p = 0.03）、巢式病例对照研究（RR：0.57，p<0.001）以及病例对照研究（RR：0.60，p<0.001）中均一致，在他汀类药物使用定义为1年内任何使用（RR：0.59，p<0.001）或随访期间使用（RR：0.61，p<0.001）的研究中也是如此。检测到显著的发表偏倚（Egger回归检验p = 0.046）。随后的“修剪和填充”分析检索到一项未发表的研究以生成对称漏斗图，纳入该研究的荟萃分析未显著影响结果（RR：0.72，95%CI：0.68至0.76，p<0.001）。使用他汀类药物可能与活动性结核感染减少相关。需要进行随机对照试验（RCT）来证实他汀类药物使用对结核感染的潜在预防作用。
