Cummings P, Psaty B M
University of Washington School of Public Health and Community Medicine, Seattle.
Ann Intern Med. 1994 May 15;120(10):848-55. doi: 10.7326/0003-4819-120-10-199405150-00006.
To review the association between low serum cholesterol and death from injury.
Relevant English-language papers identified through MEDLINE and Current Contents searches and bibliographies of identified articles.
More than 150 articles were reviewed to identify data, meta-analyses, or important reviews of the association between low cholesterol and injuries.
Estimates of the association between cholesterol and death from injury were extracted from published reports.
Animal studies and descriptive studies have provided little information about serum cholesterol and injuries. The Conference on Low Blood Cholesterol pooled results from 14 cohort studies in men and found a relative risk of 1.4 for death from injury in men whose cholesterol levels were lower than 4.14 mmol/L (160 mg/dL) compared with men whose cholesterol levels were 4.14 to 5.15 mmol/L (P = 0.003). Most cohort studies support this finding. The strongest evidence that cholesterol and death from injury are related comes from a meta-analysis of six randomized cardiac primary prevention trials of cholesterol reduction; the relative risk for death from injury for treated men compared with controls was 1.42 (95% Cl, 0.94 to 2.15).
In cohort studies, the strength of the association between low serum cholesterol levels and subsequent death from injury is weak and may be caused by confounding factors such as socioeconomic status. The modestly elevated risk ratio found in a meta-analysis of trials of cholesterol reduction in men is of borderline statistical significance. This association may be related to efforts to lower cholesterol rather than to low absolute levels of serum cholesterol. Until more data are available, the hypothesized relation between low cholesterol and injuries remains unsettled.
回顾低血清胆固醇与损伤死亡之间的关联。
通过医学文献数据库（MEDLINE）和《现刊目次》检索以及已识别文章的参考文献确定的相关英文论文。
对150多篇文章进行了综述，以确定有关低胆固醇与损伤之间关联的数据、荟萃分析或重要综述。
从已发表的报告中提取胆固醇与损伤死亡之间关联的估计值。
动物研究和描述性研究提供的关于血清胆固醇与损伤的信息很少。低血胆固醇会议汇总了14项男性队列研究的结果，发现胆固醇水平低于4.14 mmol/L（160 mg/dL）的男性与胆固醇水平为4.14至5.15 mmol/L的男性相比，损伤死亡的相对风险为1.4（P = 0.003）。大多数队列研究支持这一发现。胆固醇与损伤死亡相关的最有力证据来自对六项降低胆固醇的随机心脏一级预防试验的荟萃分析；与对照组相比，接受治疗的男性损伤死亡的相对风险为1.42（95%可信区间，0.94至2.15）。
在队列研究中，低血清胆固醇水平与随后损伤死亡之间的关联强度较弱，可能是由社会经济地位等混杂因素导致的。在对男性降低胆固醇试验的荟萃分析中发现的风险比适度升高，具有临界统计学意义。这种关联可能与降低胆固醇的努力有关，而不是与血清胆固醇的绝对低水平有关。在有更多数据之前，低胆固醇与损伤之间的假设关系仍未确定。
