依折麦布联合他汀类药物调血脂对主要心血管事件影响的系统评价

目的 系统评价依折麦布联合他汀类药物与单药应用双倍剂量他汀调血脂治疗中对主要心血管事件的影响。方法 检索CENTRAL、PubMed、EMBASE、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）和万方等数据库，收集依折麦布联合他汀类药物与双倍剂量他汀类药物调脂治疗心血管不良事件的随机对照试验（RCT），检索时限均从建库至2018年4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R3.3.1软件进行数据分析。结果 共纳入16个RCTs，共3 534例患者。Meta-分析结果显示与单药应用双倍剂量他汀组相比，依折麦布联合他汀组可降低心绞痛［RR=0.36，95% CI（0.21，0.63），P=0.000 3］、心肌梗死［RR=0.59，95% CI（0.36，0.95），P=0.03］和主要心血管不良事件（心源性死亡、心绞痛、心肌梗死、血运重建）［RR=0.58，95% CI（0.38，0.87），P=0.009］的发生风险，且具有统计学差异；两组血运重建、心源性死亡、卒中和全因死亡风险无统计学差异。结论 现有证据表明依折麦布联合他汀类药物比单药应用双倍剂量他汀能进一步降低不良心血管事件发生风险，但上述结果尚需更多多中心、大样本随机对照试验进一步证实。

A systematic review of effects of ezetimibe combined with statins on major cardiovascular events

Objective To systemically review ezetimibe combining statins versus double-dose statins therapy on major cardiovascular diseases. Methods Relative randomized controlled trials (RCT) about ezetimibe combining statins versus doubledose statins therapy for treating major adverse cardiovascular events were searched in Cochrane Library, PubMed, EMBASE, CBM database, CNKI database, and Wanfang database from their inception to April 1, 2018. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. The meta-analysis was conducted by using RevMan 5.3 and R 3.3.1 software. Results A total of 16 RCTs involving 3 534 patients were included. The results of meta-analysis showed that compared with double-dose statins therapy, ezetimibe combining statins significantly decreased the incidence of anginaRR=0.36, 95%CI(0.21, 0.63), P=0.0003], myocardial infarctionRR=0.59, 95%CI(0.36, 0.95), P=0.03] and major adverse cardiovascular events (cardiogenic death, angina, myocardial infarction, revascularization)RR=0.58, 95%CI(0.38, 0.87), P=0.009]. However, no statistic difference was found in revascularization, cardiogenic death, stroke, and all-cause mortality. Conclusion Current evidence shows that compared with double-dose statins therapy, ezetimibe combining statins therapy can reduce the risk of cardiovascular events. However, more multicentre and large-scale RCTs need to be conducted to verify this conclusion.