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目的系统性评价他汀类药物用于治疗急性呼吸窘迫综合征(ARDS)患者的有效性和安全性。方法计算机检索和手工检索收集有关他汀类药物治疗ARDS患者的随机对照研究(RCT)文献,按纳入与排除标准选择文献,评价纳入文献质量,提取资料,采用Rev Man 5.3软件对数据进行Meta分析。结果共纳入5篇RCT研究文献,共入选1 489例患者,其中他汀类治疗组709例,安慰剂对照组780例。Meta分析显示,与安慰剂对照组比,他汀类治疗组无法降低ARDS患者病死率(RR=1.01,95%CI 0.86~1.18,P=0.91),无法改善ARDS患者的氧合状态(MD=3.92,95%CI-14.10~21.94,P=0.67),也无法缩短其非机械通气时间(MD=0.65,95%CI-0.20~1.50,P=0.13)以及无肺外器官功能障碍时间(MD=1.20,95%CI-1.46~3.87,P=0.38)。安全性评价显示他汀类治疗组肌酸激酶(CK)值显著升高(MD=6.92,95%CI 5.77~8.07,P<0.000 01)。结论与安慰剂对照组相比,他汀类药物无法改善ARDS患者的预后,其安全性亦需进一步评估。
Objective To systematically evaluate the efficacy and safety of statins in the treatment of patients with acute respiratory distress syndrome (ARDS). METHODS: Randomized controlled studies (RCTs) on statin-treated ARDS patients were collected by computerized searching and hand-searched. The literature was selected according to the inclusion and exclusion criteria, the quality of the included literature was evaluated, the data were extracted, and the data were analyzed by Meta-analysis using Rev Man 5.3 software. Results A total of 5 RCTs were included in the study, enrolling 1 489 patients, of whom 709 in the statin group and 780 in the placebo group. Meta-analysis showed that the statin-treated group was not able to reduce the mortality of patients with ARDS (RR = 1.01, 95% CI 0.86 to 1.18, P = 0.91) and did not improve the oxygenation status of patients with ARDS (MD = 3.92 (MD = 0.65, 95% CI-0.20 to 1.50, P = 0.13) and no extra-pulmonary organ dysfunction time (MD = 0.65, 95% CI-14.10 to 21.94, P = 0.67) 1.20, 95% CI-1.46 to 3.87, P = 0.38). Safety evaluation showed a significant increase in creatine kinase (CK) value in the statin-treated group (MD = 6.92, 95% CI 5.77 to 8.07, P <0.000 01). Conclusion Compared with placebo control group, statins can not improve the prognosis of patients with ARDS, its safety needs further evaluation.