瑞舒伐他汀降压作用的meta分析

doi:10.3969/j.issn.1004-583X.2023.11.001

摘要/Abstract

摘要：

目的评价瑞舒伐他汀联合降压药物对高血压合并血脂异常患者的降压疗效及安全性。方法计算机检索PubMed、WOS核心合集(含SCIE、SSCI、A&HCI、CPCI数据库)、The Cochrane Library、中国知网、万方数据库、维普网,检索时限均为建库至2022 年11月,收集瑞舒伐他汀联合降压药物与单独降压药物治疗高血压合并血脂异常患者的随机对照试验,由2位研究者按纳入和排除标准独立筛选文献、提取资料、交叉核对并进行方法学质量评估后,采用用STATA12.0软件进行Meta分析。结果共纳入11项随机对照研究,共1275例患者,其中试验组(瑞舒伐他汀联合降压药物)696例,对照组(单独降压药物)579例。Meta分析结果显示:试验组血压下降幅度大于对照组(收缩压: $W M D$ =-1.97,95% $C I$ :-3.55~0.38, $P$ =0.02;舒张压: $W M D$ =-1.24,95% $C I$ :-2.20~-0.29, $P$ =0.01);其中亚组分析显示,瑞舒伐他汀与两类降压药物(氨氯地平+沙坦类降压药)三联用药的降压效果更显著(收缩压: $W M D$ =-4.06,95% $C I$ :-6.84~-1.29, $P$ =0.004;舒张压: $W M D$ =-1.46,95% $C I$ :-2.90~-0.02, $P$ =0.047);且两组治疗方案的药物不良反应差异无统计学意义( $O R$ =1.17,95% $C I$ :0.73~1.86, $P$ =0.52)。结论与单独使用降压药物相比较,瑞舒伐他汀联合降压药可更有效的降低血压水平,其中瑞舒伐他汀与氨氯地平以及沙坦类降压药三联用药的降压效果更显著,且不会增加药物不良反应。

关键词: 瑞舒伐他汀, 氨氯地平, 沙坦类降压药, meta分析, 随机对照研究

Abstract:

Objective To evaluate the antihypertensive efficacy and safety of rosuvastatin combined with antihypertensive drugs on hypertension patients combined with dyslipidemia. Methods Randomized controlled trials (RCT) reporting the treatment of rosuvastatin combined with antihypertensive drugs versus the monotherapy of antihypertensive drugs in hypertension patients combined with dyslipidemia published before November 2015 were systematically searched in the online databases of PubMed, The Cochrane Library and the Web of Science Core Collection (including the SCIE, SSCI, A&HCI, and CPCI databases). Two investigators were independently responsible for screening eligible literatures based on the inclusion and exclusion criteria, extracting data, cross-checking and evaluating the quality. Meta-analysis was performed using STATA12.0 software. Results A total of 11 RCTs involving 1275 hypertension patients combined with dyslipidemia were included. Among them, 696 patients were included in the experimental group (rosuvastatin combined with antihypertensive drugs) and 579 were in the control group (monotherapy of antihypertensive drugs). Meta-analysis showed that the blood pressure decrease in the experimental group was significantly greater than that of the control group (systolic blood pressure: $W M D$ =-1.97, 95% $C I$ : -3.55, -0.38, $P$ =0.02; diastolic blood pressure: $W M D$ =-1.24, 95% $C I$ : -2.20, -0.29, $P$ =0.01). Subgroup analysis showed the tripe therapy of rosuvastatin combined with two types of antihypertensive drugs (amlodipine + sartan) presented the most significant antihypertensive effect (systolic blood pressure: $W M D$ =-4.06, 95% $C I$ : -6.84, -1.29, $P$ =0.004; diastolic blood pressure: $W M D$ =-1.46, 95% $C I$ : -2.90, -0.02, $P$ =0.047). No significant difference in the incidence of adverse events was found between the experimental group and control group ( $O R$ =1.17, 95% $C I$ : 0.73-1.86, $P$ =0.52). Conclusion Rosuvastatin combined with antihypertensive drugs lowers blood pressure more effectively compared with the monotherapy of antihypertensive drugs, and the triple therapy of rosuvastatin, amlodipine and sartan has a more significant antihypertensive effect without increasing adverse drug effects.

Key words: rosuvastatin, amlodipine, sartan antihypertensive drugs, meta-analysis, randomized controlled study

中图分类号:

R972.6

柯孟婷, 陈慰. 瑞舒伐他汀降压作用的meta分析[J]. 临床荟萃, 2023, 38(11): 965-971.

Ke Mengting, Chen Wei. Meta-analysis of the antihypertensive effects of rosuvastatin[J]. Clinical Focus, 2023, 38(11): 965-971.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.11.001

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I11/965

图/表 8

图1 文献筛选流程图

Fig.1 Flow diagram of articles selection

表1 纳入研究的基本信息表

Tab.1 Characteristic of included studies of the meta-analysis

纳入研究	年份	例数		干预措施		疗程 (周)	基线比较	结局指标
纳入研究	年份	试验组	对照组	试验组	对照组	疗程 (周)	基线比较	结局指标
Jo^[3]	2022	105	52	瑞舒伐他汀+氨氯地平+奥美沙坦	氨氯地平+奥美沙坦	8	是	SBP、DBP
Kim^[4]	2020	35	34	瑞舒伐他汀+氨氯地平	氨氯地平	8	是	SBP、DBP
Lee^[5]	2017	54	46	瑞舒伐他汀+氨氯地平+氯沙坦	氨氯地平+氯沙坦	8	是	SBP、DBP
Cho^[6]	2019	70	72	瑞舒伐他汀+坎地沙坦	坎地沙坦	8	是	SBP、DBP
Jin^[7]	2020	66	66	瑞舒伐他汀+氨氯地平+替米沙坦	氨氯地平+替米沙坦	8	是	SBP、DBP
Park^[8]	2016	61	36	瑞舒伐他汀+奥美沙坦	奥美沙坦	8	是	SBP、DBP
Oh^[9]	2018	80	43	瑞舒伐他汀+替米沙坦	替米沙坦	8	是	SBP、DBP
Rhee^[10]	2020	92	93	瑞舒伐他汀+奈必洛尔	奈必洛尔	8	是	SBP、DBP
Hong^[11]	2019	47	49	瑞舒伐他汀+氨氯地平+替米沙坦	氨氯地平+替米沙坦	8	是	SBP、DBP
Kim^[12]	2019	40	43	瑞舒伐他汀+氨氯地平+替米沙坦	氨氯地平+替米沙坦	8	是	SBP、DBP
Rhee^[13]	2017	46	45	瑞舒伐他汀+非马沙坦	非马沙坦	8	是	SBP、DBP

图2 纳入研究质量评价图

Fig.2 Quality evaluation diagram of included studies of the meta-analysis

图3 两组治疗前后收缩压差值比较的森林图

Fig. 3 Forest plots comparing the systolic pressure difference before and after treatment between groups

图4 两组治疗前后舒张压差值比较的森林图

Fig. 4 Forest plots comparing the diastolic pressure difference before and after treatment between groups

图5 两组治疗后药物不良反应比较的森林图

Fig. 5 Forest plot of the adverse drug reactions between groups

图6 偏倚风险图 a.两组治疗前后收缩压差值比较的偏倚风险图;b.两组治疗前后舒张压差值比较的偏倚风险图;c.两组治疗前后药物不良反应比较的偏倚风险图

Fig. 6 Bias risk diagram a. the diagram for comparing the systolic pressure difference; b. the diagram for comparing the diastolic pressure difference; c. the diagram for comparing the adverse drug reactions

图7 敏感性分析图 a.两组治疗前后收缩压差值比较的偏倚风险图;b.两组治疗前后舒张压差值比较的偏倚风险图;c.两组治疗前后药物不良反应比较的偏倚风险图

Fig. 7 Sensitivity analysis diagram a. the diagram for comparing the systolic pressure difference; b. the diagram for comparing the diastolic pressure difference; c. the diagram for comparing the adverse drug reactions

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