甲氨蝶呤可预防类风湿关节炎患者的心血管事件：一项更新的荟萃分析。
Methotrexate can prevent cardiovascular events in patients with rheumatoid arthritis: An updated meta-analysis.
机构信息
Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, China.
出版信息
Medicine (Baltimore). 2021 Feb 19;100(7):e24579. doi: 10.1097/MD.0000000000024579.
AIMS
The incidence of cardiovascular events (CVEs) in patients with rheumatoid arthritis (RA) is higher than that in people without RA. This may be because inflammation promotes the progression of atherosclerosis. Anti-inflammatory drugs might reduce the occurrence of CVEs in patients with RA. Methotrexate (MTX) is a conventional synthetic anti-rheumatic drug that is widely used in the treatment of RA. We performed a meta-analysis to determine whether MTX can prevent CVEs in RA patients. Then, we discussed the possibility of using MTX to prevent recurred CVEs in patients with coronary heart disease (CHD).
METHODS
We searched PubMed, Embase, Web of Science, and the Cochrane Library using the key words "methotrexate," "cardiovascular," "acute coronary syndrome," "coronary heart disease," "myocardial infarction," "angina pectoris," and "rheumatoid arthritis." The efficacy outcome was defined as a composite of CVEs, including stable angina, acute coronary syndrome, stroke, heart failure, and cardiac death.
RESULTS
A total of 10 studies and 195,416 RA patients were included in our meta-analysis, and the effect size of relative risk (RR) was pooled using a fixed effect model. The results showed that MTX prevented CVEs in RA patients (RR: 0.798, 95% CI 0.726-0.876, P = .001, I2 = 27. 9%).
CONCLUSION
MTX can prevent CVEs in RA patients, but there is not sufficient evidence for using MTX to treat patients with CHD.
目的
类风湿关节炎（RA）患者的心血管事件（CVE）发生率高于无 RA 患者。这可能是因为炎症促进了动脉粥样硬化的进展。抗炎药可能会降低 RA 患者 CVE 的发生。甲氨蝶呤（MTX）是一种常用的传统合成抗风湿药物，广泛用于 RA 的治疗。我们进行了一项荟萃分析，以确定 MTX 是否可以预防 RA 患者的 CVE。然后，我们讨论了使用 MTX 预防冠心病（CHD）患者再次发生 CVE 的可能性。
方法
我们使用“methotrexate”、“cardiovascular”、“acute coronary syndrome”、“coronary heart disease”、“myocardial infarction”、“angina pectoris”和“rheumatoid arthritis”等关键词在 PubMed、Embase、Web of Science 和 Cochrane Library 中进行了检索。疗效结局定义为 CVE 的综合指标，包括稳定性心绞痛、急性冠状动脉综合征、中风、心力衰竭和心脏性死亡。
结果
共有 10 项研究和 195416 名 RA 患者纳入了我们的荟萃分析，使用固定效应模型汇总相对风险（RR）的效应量。结果表明，MTX 可预防 RA 患者的 CVE（RR：0.798，95%CI 0.726-0.876，P=0.001，I2=27.9%）。
结论
MTX 可预防 RA 患者的 CVE，但尚无充分证据表明使用 MTX 治疗 CHD 患者。
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