他汀类药物对肝硬化门静脉高压症疗效的Meta分析

摘要

目的 系统评价他汀类药物对肝硬化门静脉高压症(PHT)患者或门静脉高压症大鼠模型门静脉压力的影响.方法 检索 PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库及维普数据库(VIP)中关于他汀类药物对肝硬化门静脉高压症疗效的随机对照临床研究或动物实验,采用Stata 12.0统计软件对入选研究进行Meta分析.结果 共10个随机对照研究符合纳入标准,其中3个临床研究(110例),另7个为动物实验,研究对象为大鼠(134只).Meta分析结果如下:(1)他汀类药物降低肝静脉压力梯度(HVPG)的幅度明显大于安慰剂组( WMD =1.308,95% CI 0.987~1.629, P =0.000);(2)他汀类药物降低失代偿期肝硬化患者HVPG的有效率明显高于代偿期肝硬化患者( RR =3.953,95% CI 1.030~15.181, P =0.045).(3)门静脉高压症大鼠模型研究中,他汀类药物可降低门静脉压力( WMD =2.318,95% CI 1.060~3.576, P =0.000).(4)他汀类药物的不良反应发生率与安慰剂相比无显著性差异( RR =0.871,95% CI 0.194~3.905, P =0.856).结论 他汀类药物可以有效降低肝硬化PHT患者或PHT大鼠模型的门静脉压力,对失代偿期肝硬化患者疗效更为显著,不良反应较少,有可能成为降低门静脉高压症患者门静脉压力的新型药物.%Objective To evaluate the effects of the statins in reducing portal hypertension (PHT) in patients or rats with cirrhosis.Methods Retrieval PubMed, Embase, Web of science, the Cochrane Library, Chinese CNKI, Wanfang database and VIP database (VIP) on clinical randomized controlled study and animal experiment of statins on liver cirrhosis and portal hypertension, selected studies were using Stata 12 statistical software to perform Meta-analysis.Results A total of ten randomized controlled trials (RCT) met the inclusion criteria, in which 3 trials were analyzed to compare the statins with the placebo in patients with cirrhosis (110 patients) and the other 7 trials were in rats (134 rats).The results of meta-analysis were as follow:(1)compared with placebo,the statins were associated with a greater reduction of hepatic vein pressure gradient(HVPG) inpatients with cirrhosis(WMD =1.308,95% CI 0.987~1.629 mmHg, P =0.000).(2)Subgroup analysis showed the effective rate of the statins to reduce HVPG in patients with decompensated liver cirrhosis was significantly greater than in patients with compensated cirrhosis (RR =3.953,95% CI 1.030-15.181, P=0.045).(3)The portal pressure(PP) of the rats in treatment group was lower than in control group(WMD =2.318,95% CI 1.060-3.576 mmHg, P=0.000).(4)There were no statistically significant differences in the incidence of adverse events between the statins treatment group and the placebo group(RR =0.871,95% CI 0.194-3.905, P =0.856).Conclusion The statins are effective in reducing portal pressure in cirrhotic patients and rats with PHT, especially in the patients with decompensated liver cirrhosis, and there are fewer adverse reactions.Statins may become a new type drug to reduce portal pressure in patients with PHT.