匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标影响的Meta分析

目的比较匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标的影响。方法计算机检索EMBase、PubMed、The Cochrane Library、万方数据知识服务平台、中国知网和维普网,检索时间为建库至2018年12月,筛选关于匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标影响的随机对照试验(RCT),其中采用匹伐他汀治疗者作为PTV组,采用阿托伐他汀治疗者作为AVT组。采用RevMan 5.3软件进行Meta分析,比较两组患者治疗后血脂指标[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血糖指标[包括空腹血糖(FBG)、糖化血红蛋白(HbA1c)]。结果最终纳入14篇文献,共1 067例患者。Meta分析结果显示,治疗后PVT组患者TC[MD=1.18,95%CI(0.37,1.99)]、HDL-C[MD=0.12,95%CI(0.03,0.22)]高于AVT组,FBG[MD=-0.71,95%CI(-1.06,0.36)]、HbA1c[MD=-0.34,95%CI(-0.53,-0.15)]低于AVT组(P<0.05);两组患者治疗后TG[MD=0.04,95%CI(-0.03,0.11)]、LDL-C[MD=-0.00,95%CI(-0.08,0.07)]比较,差异无统计学意义(P>0.05)。绘制报道HbA1c文献发表偏倚的倒漏斗图发现,分布于直线两侧的散点不对称,提示可能存在发表偏倚;绘制报道TG文献发表偏倚的倒漏斗图发现,分布于直线两侧的散点对称,提示无发表偏倚。结论现有文献证据表明,匹伐他汀与阿托伐汀对冠状动脉疾病、血脂异常、糖耐量异常患者TG、LDL-C的影响相似,而与阿托伐他汀相比,匹伐他汀能更有效地降低患者FBG、HbA1c,升高患者HDL-C,但降低患者TC的效果不如阿托伐他汀。

Impact on Blood Lipid Parameters and Blood Glucose Related Index between Pitavastatin and Atorvastatin in Patients with Coronary Artery Disease,Dyslipidemia or Impaired Glucose Tolerance:a Meta-analysis

Objective To compare the impact on blood lipid parameters and blood glucose related index between pitavastatin and atorvastatin in patients with coronary artery disease,dyslipidemia or impaired glucose tolerance. Methods Computer was used to search EMBase,PubMed,The Cochrane Library,Wanfang Data,CNKI and VIP from building database to December 2018,to screen RCTs about impact on blood lipid parameters and blood glucose related index between pitavastatin and atorvastatin in patients with coronary artery disease,dyslipidemia or impaired glucose tolerance,thereinto patients treated by pitavastatin were served as PTV group,the other patients treated by atorvastatin were served as AVT group. Meta-analysis was carried out by RevMan 5.3 software. Blood lipid parameters(including TC,TG,LDL-C and HDL-C)and blood glucose related index(including FBG and HbA1 c)were compared between the two groups after treatment. Results A total of 14 literatures were enrolled eventually,including 1,067 patients. Meta-analysis results showed that,TC[MD=1.18,95%CI(0.37,1.99)]and HDL-C[MD=0.12,95%CI(0.03,0.22)]in PTV group were statistically significantly higher than those in ATV group after treatment(P<0.05),while FBG[MD=-0.71,95%CI(-1.06,0.36)]and HbA1 c[MD=-0.34,95%CI(-0.53,-0.15)]in PTV group were statistically significantly lower than those in ATV group(P<0.05);there was no statistically significant difference in TG[MD=0.04,95%CI(-0.03,0.11)] or LDL-C[MD=-0.00,95%CI(-0.08,0.07)]between the two groups after treatment(P>0.05). Inverted funnel plot for publication bias of literatures reported Hb A1 c showed that,the scattered points on both sides of the line were asymmetric,indicating existence of publication bias;inverted funnel plot for publication bias of literatures reported TG showed that,the scattered points on both sides of the line were symmetric,thus there was no publication bias. Conclusion Available literature evidence suggests that,pitavastatin and atorvastatin have similar impact on TG and LDL-C in patients with coronary artery disease,dyslipidemia or impaired glucose tolerance,and compared with atorvastatin,pitavastatin can more effectively reduce FBG and Hb A1 c,as well as increase HDL-C,but not as good as atorvastatin in lowing TC.