Meregildo-Rodriguez Edinson Dante, Chunga-Chévez Eleodoro Vladimir, Gianmarco Robles-Arce Luis, Vásquez-Tirado Gustavo Adolfo
Universidad César Vallejo, Escuela de Medicina. Trujillo, Perú.
Universidad Privada Antenor Orrego, Escuela de Medicina, Trujillo, Perú.
Infez Med. 2022 Jun 1;30(2):194-203. doi: 10.53854/liim-3002-4. eCollection 2022.
Tuberculosis is a major cause of global morbidity and mortality. Statins could be associated with a lower risk of some infectious diseases, including tuberculosis. Statins could reduce the risk of latent tuberculosis infection and active tuberculosis, acting as an adjuvant in treating tuberculosis. This study aimed to determine if statins reduce the risk of active tuberculosis.
We systematically analyzed 8 databases from inception to December 2021. We included articles without language restriction if they met our inclusion and exclusion criteria and the PECO strategy (Population: adults without active pulmonary tuberculosis; treatment with any statin; Comparator: no use of statins; Outcome: active tuberculosis). Odds Ratios (ORs) with 95% confidence intervals (CIs) were pooled using random- effects models regardless of heterogeneity quantified by Cochran's Q and I statistics. We performed subgroup analyses according to the participants' diabetic status and follow-up length (≤10 years or >10 years).
Twelve articles reporting observational studies involving 3.038.043 participants, including at least 32.668 cases of active tuberculosis. Eight reported retrospective cohort studies, three nested case-control study, and one was a case control study.According to our meta-analysis, statins may reduce the risk of active tuberculosis, in the general population (OR 0.66; 95% CI, 0.54-0.81), in non-diabetic (OR 0.66; 95% CI, 0.54-0.80) and in diabetic patients (OR 0.65; 95% CI, 0.49-0.87). This protective effect did not differ according to the participants' diabetic status nor follow-up length (test for subgroup differences I=0). We found significant clinical and methodological heterogeneity. Similarly, the forest plot, and the I and Chi statistics suggested considerable statistical heterogeneity (I=95%, p<0.05, respectively). Of the 12 included studies, 9 were at low risk of bias and 3 were at high risk of bias. Similarly, according to the funnel plot, it is very likely that there are important publication biases.
Statin use may significantly reduce the risk of tuberculosis in the general population, diabetic and non-diabetic patients. Nevertheless, caution should be exercised when interpreting these conclusions, due to the quality of the evidence, the heterogeneity of the studies, the presence of bias, and the difficulty in extrapolating these results to populations of other races and ethnicities.
结核病是全球发病和死亡的主要原因。他汀类药物可能与包括结核病在内的某些传染病风险降低有关。他汀类药物可降低潜伏性结核感染和活动性结核病的风险，可作为治疗结核病的辅助药物。本研究旨在确定他汀类药物是否能降低活动性结核病的风险。
我们系统分析了从开始到2021年12月的8个数据库。如果文章符合我们的纳入和排除标准以及PECO策略（人群：无活动性肺结核的成年人；使用任何他汀类药物治疗；对照：未使用他汀类药物；结局：活动性结核病），则纳入无语言限制的文章。使用随机效应模型汇总比值比（OR）及其95%置信区间（CI），无论通过Cochran's Q和I统计量量化的异质性如何。我们根据参与者的糖尿病状态和随访时间（≤10年或>10年）进行亚组分析。
12篇报告观察性研究的文章涉及3038043名参与者，包括至少32668例活动性结核病例。8篇报告了回顾性队列研究，3篇为巢式病例对照研究，1篇为病例对照研究。根据我们的荟萃分析，他汀类药物可能会降低一般人群（OR 0.66；95%CI，0.54 - 0.81）、非糖尿病患者（OR 0.66；95%CI，0.54 - 0.80）和糖尿病患者（OR 0.65；95%CI，0.49 - 0.87）中活动性结核病的风险。这种保护作用在参与者的糖尿病状态和随访时间方面没有差异（亚组差异检验I = 0）。我们发现了显著的临床和方法学异质性。同样，森林图以及I和卡方统计表明存在相当大的统计异质性（I分别为95%，p < 0.05）。在纳入的12项研究中，9项偏倚风险较低，3项偏倚风险较高。同样，根据漏斗图，很可能存在重要的发表偏倚。
使用他汀类药物可能会显著降低一般人群、糖尿病患者和非糖尿病患者患结核病的风险。然而，由于证据质量、研究的异质性、偏倚的存在以及将这些结果外推到其他种族和族裔人群的困难，在解释这些结论时应谨慎。
