贝特类调脂药物预防心脑血管疾病的系统评价

目的研究吉非罗齐、非诺贝特和苯扎贝特3种贝特类药物对心、脑血管事件的作用。方法系统性检索Cochrane图书馆临床对照试验数据库（CCTR2011年第4期）、MEDLINE（1950-2011）、EMBase（1950-2011），并纳入所有对比3种贝特类药物（吉非罗齐、非诺贝特和苯扎贝特）与安慰剂或空白组预防心脑血管疾病随访时间不少于1年的随机对照试验。由两名评价员独立评价文献质量、提取资料并交叉核对，而后采用MetaAnalystbeta3．13软件进行荟萃分析。结果研究最终纳入11项随机对照试验。与安慰剂或空白对照组相比，吉非罗齐、非诺贝特、苯扎贝特3种贝特类药物对全因死亡率和脑卒中均无明显影响，其全因死亡率风险比（95％可信区间）RR（95％CI）]分别为0．985（0．830-1．169）、1．023（0．905-1．155）、0．948（0．837-1．073），脑卒中RR（95％CI）分别为0．765（0．548-1．067）、0．865（0．646-1．158）、1．056（0．772-1．081）。3种贝特类药物均能显著降低患者非致死性心肌梗死发生率，其RR（95％CI）分别为0．776（0．646-0．931）、0．833（0．717-0．968）、0．752（0．591-0．958）。此外，吉非罗齐和非诺贝特与安慰剂相比均可显著降低10％-20％的全部心血管事件，而3种贝特类药物对肿瘤发生率和肿瘤归因死亡率均不具有显著作用。结论与安慰剂相比，贝特类药物可以显著降低心肌梗死等心血管事件的风险，但对全因死亡率和肿瘤的发生率没有显著影响。

Effects of fibrates on the macrovascular events: a systematic review

Objective To investigate the effects of gemfibrozil, fenobrate, and bezafibrate on the macrovascular events. Methods We collected all prospective, randomized control clinical trials comparing the effects of 3 fibrates （fenofibrate, bezafibrate, and gemfibrozil ） with placebo or blank controls with maerovaseular end points reported from CCTR （ Issue 4,2011 ） , MEDLINE （ 1950 - 2011 ） , and EMBASE （1950- 2011 ）. Data collection and quality evaluation have been done by two reviewers, independently. Meta Analyst beta 3.13 had been used for statistical analysis. Results This study included 11 randomized control clinical trials. Compared with placebo or blank control, none of gemfibrozil, fenofibrate or bezafibrate decreased the risk of all cause mortality or stroke incidence （ all cause mortality, RR 0. 985, 95% CI O. 830 to 1. 169 ; RR 1. 023, 95% CI O. 905 to 1. 155 ; RR 0. 948, 95% CI O. 837 to 1. 073, respectively; stroke incidence, RR 0. 765,95% C10. 548 to 1. 067 ; RR 0. 865, 95% CI O. 646 to 1. 158 ; RR 1. 056, 95% CI 0. 772 to 1. 081, respectively）. All three fibrates could significantly decrease the risk of non-fatal myocardial infarction （RR 0. 776, 95% CI 0. 646 to 0. 931 ; RR 0. 833, 95% CI0. 717 to 0. 968 ; RR 0. 752, 95% CI 0. 591 to 0. 958, respectively）. Compared with placebo, gemifibrozil and fenofibrate could significantly decrease 10% - 20% risk of all cardiovascular events, and no significant difference was found in cancer incidence and mortality. Conclusion Fibrates could reduce the risk of non-fatal myocardial infarction but not all-cause mortality or stroke.