阿托伐他汀和氟伐他汀调节血脂异常临床效果的Meta分析

目的 综合分析阿托伐他汀和氟伐他汀调节血脂异常的疗效、安全性和经济学效益.方法 计算机检索Cochrane 图书馆、PubMed、Medline、Embase、Wiley、Springer数据库,中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、中文科技期刊数据库(VIP),检索时间从建库至2016年6月.筛选阿托伐他汀和氟伐他汀调节血脂异常的临床随机对照研究(RCT),由两位研究者进行独立的文献评价和交叉核对,对文献报道的治疗前后高密度脂蛋白胆固醇((HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)和总胆固醇(TC)等指标的变化进行Meta分析,并进行经济学评价.结果 最终纳入7篇文献,服用氟伐他汀者684例,服用阿托伐他汀者2 208例.阿托伐他汀降低LDL-C、TC和TG水平的作用明显优于氟伐他汀,差异均有统计学意义(Z=23.63、23.32、5.50,P＜0.000 01);而对HDL-C水平的影响两种药物比较,差异无统计学意义(Z=1.01,P=0.31).阿托伐他汀提高疗效增加总费用低于氟伐他汀.结论 阿托伐他汀调节LDL-C、TC、TG的作用较氟伐他汀更强,而升高HDL-C的作用二者无明显差异,且阿托伐他汀经济学效应更具优势.

Comparison of clinical efficacy of atorvastatin and fluvastatin on regulating dyslipidemia:a Meta analysis

Objective To comprehensively evaluate the clinical efficacy,safety and economic benefits of atorvastatin and fluvastatin in regulating dyslipidemia.Methods The clinical randomized controlled trials (RCTs) for comparing clinical efficacy of atorvastatin and fluvastatin on regulating dyslipidemia were retrieved from databases,including Cochrane Library,PubMed,Medline,Embase,Wiley,Springer,CNKI,Wanfang and VIP,till June 2016.Data were evaluated by two reviewers independently according to the Jadad standard.The changes of low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),total cholesterol (TC) and triglyceride (TG) before and after treatment were extracted to perform Meta-analysis by using RevMan5.0 software.The economic evaluation was carried out,as well.Results A total of 7 RCTs were included,including 684 cases of patients treated with fluvastatin and 2 208 cases of patients treated with atorvastatin.The patients were spitted into two subgroups according to the same or different maximum dose of atorvastatin and fluvastatin.The results indicated that the effects of atorvastatin on down-regulating LDL-C,TC and TG levels were significantly better than those of fluvastatin,the differences were statistically significant (Z=23.63、23.32、5.50,P＜0.000 01).No significant difference was found in regulating HDL-C level between atorvastatin and fluvastatin.Conclusion Compared with fluvastatin,atorvastatin is more effective to regulate levels of LDL-C,TC and TG,but there is no significant difference in up-regulating HDL-C level.Additionally,application of atorvastatin is more economicallv effective.