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目的运用meta分析的方法综合评价阿托伐他汀对不同类型脑卒中的预防作用。方法依据Cochrane系统评价方法,计算机检索国内外医学文献数据库,收集2000年1月—2014年1月所有已经发表的关于阿托伐他汀的临床随机对照试验(RCT),采用Cochrane协作网提供的系统评价软件Rev Man5.1对符合纳入标准的研究资料进行meta分析。结果共有10个阿托伐他汀相关的RCT纳入分析。meta分析结果表明,脑卒中高危人群中,阿托伐他汀组比对照组所有脑卒中发生率显著降低[RR=0.78,95%CI(0.71,0.85),假设检验z=5.35,P<0.000 01],差异有统计学意义;阿托伐他汀组比对照组致死性卒中发生率降低显著[RR=0.73,95%CI(0.61,0.87),假设检验z=3.47,P=0.000 5],差异有统计学意义;但阿托伐他汀组比对照组出血性卒中发生率也显著增高[RR=1.52,95%CI(1.02,2.28),假设检验z=2.04,P=0.04],差异有统计学意义。结论目前证据证明阿托伐他汀能明显降低脑卒中的发生率和死亡率,但可以显著增加出血性卒中的发生率,因此对有脑出血病史的患者一定要谨慎使用阿托伐他汀。
Objective To evaluate the preventive effect of atorvastatin on different types of stroke by meta-analysis. Methods According to the Cochrane systematic review method, all databases of medical literature at home and abroad were searched by computer, and all published clinical randomized controlled trials (RCTs) on atorvastatin from January 2000 to January 2014 were collected. The system provided by the Cochrane Collaboration RevMan5.1, a meta-analysis of research material that meets the inclusion criteria, Results A total of 10 atorvastatin-related RCTs were included in the analysis. Meta-analysis showed that the incidence of stroke was significantly lower in the atorvastatin group than in the control group at high risk of stroke [RR = 0.78, 95% CI (0.71, 0.85), hypothesis test z = 5.35, P <0.000 01 ], The difference was statistically significant. The incidence of fatal stroke in atorvastatin group was significantly lower than that in control group [RR = 0.73, 95% CI (0.61,0.87), hypothesis test z = 3.47, P = 0.0005] (RR = 1.52, 95% CI (1.02,2.28), hypothesis test z = 2.04, P = 0.04], the difference was statistically significant Significance of learning. Conclusions Current evidence suggests that atorvastatin can significantly reduce the incidence of stroke and mortality, but can significantly increase the incidence of hemorrhagic stroke. Therefore, atorvastatin must be used with caution in patients with a history of ICH.