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依折麦布联合他汀与双倍剂量他汀对冠心病患者降脂效果的系统评价

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摘要:

目的 系统评价依折麦布联合他汀对血脂不达标冠心病患者血脂水平的作用。方法 检
索Cochrane Library、PubMed、Embase、CBM、CNKI、万方、维普数据库,搜集依折麦布联合他汀与
双倍剂量他汀治疗血脂不达标冠心病患者的随机对照试验,检索时限均从建库至2017年6月1日。由2
名评价员独立筛选文献、提取资料并评价纳入研究的方法学质量,采用RevMan 5.3和R 3.2.3软件进行
数据分析。结果 共纳入17个RCT,共2377例患者。Meta分析结果显示,与双倍剂量他汀组相比,依
折麦布联合他汀组能显著降低血脂不达标冠心病患者低密度脂蛋白胆固醇(LDL-C)(MD=-0.37,
95%CI:-0.41~-0.34,P<0.00001)和总胆固醇(TC)(MD=-0.39,95%CI:-0.45~-0.33,P
<0.00001),明显提高血脂不达标冠心病患者LDL-C达标率(OR=3.93,95%CI:2.47~6.25,P
<0.00001),差异均具有统计学意义。对于高密度脂蛋白胆固醇(HDL-C)和三酰甘油(TG)水
平,两组无显著性差异(MD=-0.00,95%CI:-0.02~0.02,P=0.83;MD=-0.04,95%CI:-0.08~0.01,
P=0.12)。结论 依折麦布联合他汀较双倍剂量他汀能更有效的降低血脂水平,明显提高降脂治疗达标
率,但上述结果尚需要更多高质量、大样本随机对照试验进一步证实。

Abstract:

Objective To systematically review the lipid-lowering effect of statins combing ezetimibe therapy
on patients with coronary heart disease who fail to achieve adequate lipid control. Methods Relative randomized
controlled trials (RCT) about lipid-lowering therapy of ezetimibe combining statins versus double-dose statins on
patients with coronary heart disease who fail to achieve adequate lipid control were searched in Cochrane Library,
PubMed, Embase, CBM, CNKI, Wanfang and VIP Databases from the date of their establishment to June 1st,
2017. Two reviewers independently screened literature,extracted data and evaluated methodological quality. The
meta-analysis was conducted by using RevMan 5.3 and R 3.2.3 software. Results A total of 17 RCTs involving
2377 patients were included. Meta analysis results show that compared with double-dose statin group, ezetimibe
combined with statin group can significantly reduce low-density lipoprotein cholesterol (LDL-C) (MD=-0.37,
95%CI: -0.41~-0.34, P<0.00001) and total cholesterol (TC) (MD=-0.39, 95%CI: -0.45~-0.33, P<0.00001),
significantly improve the rate of LDL-C compliance in patients with coronary heart disease who do not meet the lipid
standard. (OR=3.93, 95%CI: 2.47~6.25, P<0.00001), the differences were statistically significant. For the levels
of high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG), there was no significant difference between
the two groups (MD=-0.00, 95%CI: -0.02~0.02, P=0.83; MD=-0.04, 95%CI: -0.08~0.01, P=0.12). Conclusion
Ezetimibe combined with statins can reduce blood lipid levels more effectively than double-dose statins, and
significantly increase the rate of achieving lipid-lowering treatment. However, the above results need more highquality,
large-sample randomized controlled trials to further confirm.

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