他汀类药物对预防胆囊结石形成及降低胆囊切除风险的系统评价

Efficacy of statins for preventing gallstone formation and reducing the risk of cholecystectom：a systematic review

摘要:

目的：系统评价他汀类药物在预防胆囊结石形成及降低胆囊切除风险的疗效。方法：计算机检索 PubMed，EMBASE，Cochrane Central Register of Controlled Trials，中国生物医学文献数据库和维普数据库等，全面搜集并纳入他汀类药物预防胆囊结石形成及降低胆囊切除风险相关的临床研究。采用RevMan5.0软件及Stata11.0软件对数据进行Meta分析。结果：纳入14篇文献，其中有5篇随机对照试验（randomized controlled trails，RCTs），3篇自身前后对照，共计140人；另外还有4篇病例对照研究，2篇队列研究，共观察811 393人，胆囊切除患者65 605例，745 788例健康人群。RCTs及自身前后对照研究结果示：他汀类药物组在降低胆汁胆固醇方面，差异有统计学意义（SMD=0.41，95％CI＝0.08～0.73，P=0.009）；他汀类药物组在降低胆固醇饱和指数方面优于对照组，差异有统计学意义（SMD=0.53，95％CI＝0.22～0.84，P=0.001）。病例对照及队列研究结果示：他汀类药物暴露1~2年（OR=0.89，95％CI＝0.84～0.94）、大于2年（OR=0.79，95％CI=0.67，0.94），较暴露时限小于1年（OR=1.13，95％CI＝1.04，1.22）在降低胆囊切除风险方面，差异有统计学意义。结论：他汀类药物的治疗能降低患者体内胆固醇饱和指数以及胆汁内胆固醇浓度，可能对抑制胆囊结石的形成有一定的作用。他汀类药物暴露1年以上可能有降低胆囊结石患者胆囊切除的风险。

Abstract:

Objective：To evaluate the efficacy of statins for preventing gallstone formation and reducing the risk of cholecystectomy. Methods：PubMed，EMBASE，Cochrane Central Register of Controlled Trials，CBM and VIP library were searched for all studies relat－ing to statins in the prevention of gallstone formation and reduction of cholecystectomy risk. Meta analysis was performed by using Rev Man 5.0 software and Stata11.0 software. Results：Fourteen studies were in enrolled including 5 RCTs，3 self pre-and post-control ob－servations，4 case-control studies，2 cohort studies with a total of 811 393 people（65 605 patients and 745 788 controls）. The result of RCTs and self-control studies showed that there were significantly statistical differences between statin group and control group in lowing biliary cholesterol concentration（SMD=0.41，95％CI＝0.08-0.73，P=0.009）. The cholesterol saturation index（CSI）（SMD=0.53，95％CI＝0.22-0.84，P=0.00１） in the statin group was significant lower than that in the control group. The Meta analysis results of case-control and cohort studies showed that there were statistical differences in reducing cholecystectomy risk among different exposure duration of statins（1-2 years：OR=0.89，95％CI＝0.84-0.94）；>2 years：OR=0.79，95％CI＝0.67-0.94）；<1 year：OR=1.13，95％CI＝1.04-1.22）. Conclusion：Statin can reduce the biliary cholesterol concentration and bile CSI and may have certain effect on inhibit－ing the formation of gallstones. The exposure duration of statins more than one year exerts effect on lowering the risk of gallstone dis－eases after cholecystectomy.