他汀類藥物治療心房顫動隨機對照試驗的Meta分析_《中國循證醫學雜志》

作者：

石偉 , 劉增長 , 蘇立 ,  殷躍輝

重慶醫科大學附屬第二醫院心血管內科，重慶市心律失常治療中心（重慶 400010）;

關鍵詞：

他汀心房顫動 Meta 分析

DOI：

10.7507/1672-2531.20090104

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目的　評價他汀類藥物抗心房顫動（房顫）的療效。
方法　采用Cochrane 系統評價的方法，計算機檢索PubMed、EMbase、EMB Reviews-Cochrane Central Register of Controlled Trials（2007 年第3 期）、中國生物醫學文獻數據庫、中文科技期刊數據庫，中國期刊全文數據庫，檢索時間截至2007 年9 月15 日，納入中外文他汀類藥物抗房顫的隨機對照試驗（RCT）。由兩名評價者獨立評價納入研究質量、提取資料并交叉核對。采用RevMan 4.3軟件進行Meta 分析。
結果　共納入5 個RCT，包括470 例房顫患者。各研究間存在統計學異質性（I2= 66.8%，P=0.02），故采用隨機效應模型進行合并分析，其結果顯示，他汀類藥物可減少房顫復發/ 發生率［RR=0.61，95%CI（0.43，0.88），P=0.008］。敏感性分析顯示結果穩定性較好，失安全數為52.91。
結論　他汀類藥物可以有效降低房顫的復發和發生率。但本研究中部分文獻質量不高，加之有關他汀類藥物預防房顫的RCT 文獻數量較少，總樣本量較小，上述結論尚有待開展大樣本、隨機、雙盲對照試驗證實。

引用本文： 石偉,劉增長,蘇立,殷躍輝. 他汀類藥物治療心房顫動隨機對照試驗的Meta分析. 中國循證醫學雜志, 2009, 09(5): 570-573. doi: 10.7507/1672-2531.20090104 復制

1.	inflammation in a canine sterile pericarditis model. Cardiovasc Res, 2004, 62(1): 105-111.
2.	Moher D, Schulz KF, Altman D. CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallelgroup randomized trials. JAMA, 2001, 285(15): 1987-1991.
3.	Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
4.	Tveit A, Grundtvig M, Gundersen T, et al. Analysis of pravastatin to prevent recurrence of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2004, 93(6): 780-782.
5.	Dernellis J, Panaretou M. Effect of C-reactive protein reduction on paroxysmal atrial fibrillation. Am Heart J, 2005, 150(5): 1064.
6.	Ozaydin M, Varol E, Aslan SM, et al. Effect of atorvastatin on the recurrence rates of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2006, 97(10): 1490-1493.
7.	Patti G, Chello M, Candura D, et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation, 2006, 114(14): 1455-1461.
8.	周培榮, 張士森, 劉玉珍. 胺碘酮與辛伐他汀聯用治療陣發性心房顫動的臨床研究. 濱州醫學院學報, 2007, 30(3): 183-184.
9.	麥勁壯, 李河, 方積乾, 等. Meta分析中失安全系數的估計. 循證醫學, 2006, 6(5): 297-303.
10.	周自強, 胡大一, 陳捷, 等. 中國心房顫動現狀的流行病學研究. 中華內科雜志, 2004, 43(7): 491-494.
11.	Lijnen P, Celis H, Fagard R, et al. Influence of cholesterol lowering on plasma membrane lipids and cationic transport systems. J Hypertens, 1994, 12(1): 59-64.
12.	Tesfamariam B, Frohlich BH, Gregg RE, et al. Differential effects of pravastatin, simvastatin, and atorvastatin on Ca2+ release and vascular reactivity. J Cardiovasc Pharmacol, 1999, 34(1): 95-101.
13.	Bolotina V, Omelyanenko V, Heyes B, et al. Variations of membrane cholesterol alter the kinetics of Ca2+-dependent K+ channels and membrane fluidity in vascular smooth muscle cells. Pflugers Arch, 1989, 415(3): 262-268.
14.	Engelmann M, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J, 2005, 26(20): 2083-2092.
15.	Kumagai K, Nakashima H, Saku K. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting.
16.	Hayashidani S, Tsutsui H, Shiomi T, et al. Fluvastatin, a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, attenuates left ventricular remodeling and failure after experimental myocardial infarction. Circulation, 2002,105 (7): 868-873.
17.	Porter KE, Turner NA, 0’Regan DJ, et al. Simvastatin reduces human atrial myofibroblast proliferation independently of cholesterol lowering via inhibition of RhoA. Cardiovasc Res, 2004, 61(4): 745-755.
18.	Shiroshita-Takeshita A, Schram G, Lavoie J, et al. Effect of simvastatin and antioxidant vitamins on atrial fibrillation promotion by atrial-tachycardia remodeling in dogs. Circulation, 2004, 110(16): 2313-2319.
19.	Pliquett RU, Cormish KG, Peuler JD, et al. Simvastatin normalizes autonomic neural control in experimental heart failure. Circulation, 2003, 107(19): 2493-2498.
20.	Welzig CM, Shin DG, Park HJ, et al. Lipid lowering by pravastatin increases parasympathetic modulation of heart rate: Galpha(i2), a possible molecular marker for parasympathetic responsiveness. Circulation, 2003, 108(22): 2743-2746.

1. inflammation in a canine sterile pericarditis model. Cardiovasc Res, 2004, 62(1): 105-111.
2. Moher D, Schulz KF, Altman D. CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallelgroup randomized trials. JAMA, 2001, 285(15): 1987-1991.
3. Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
4. Tveit A, Grundtvig M, Gundersen T, et al. Analysis of pravastatin to prevent recurrence of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2004, 93(6): 780-782.
5. Dernellis J, Panaretou M. Effect of C-reactive protein reduction on paroxysmal atrial fibrillation. Am Heart J, 2005, 150(5): 1064.
6. Ozaydin M, Varol E, Aslan SM, et al. Effect of atorvastatin on the recurrence rates of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2006, 97(10): 1490-1493.
7. Patti G, Chello M, Candura D, et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation, 2006, 114(14): 1455-1461.
8. 周培榮, 張士森, 劉玉珍. 胺碘酮與辛伐他汀聯用治療陣發性心房顫動的臨床研究. 濱州醫學院學報, 2007, 30(3): 183-184.
9. 麥勁壯, 李河, 方積乾, 等. Meta分析中失安全系數的估計. 循證醫學, 2006, 6(5): 297-303.
10. 周自強, 胡大一, 陳捷, 等. 中國心房顫動現狀的流行病學研究. 中華內科雜志, 2004, 43(7): 491-494.
11. Lijnen P, Celis H, Fagard R, et al. Influence of cholesterol lowering on plasma membrane lipids and cationic transport systems. J Hypertens, 1994, 12(1): 59-64.
12. Tesfamariam B, Frohlich BH, Gregg RE, et al. Differential effects of pravastatin, simvastatin, and atorvastatin on Ca2+ release and vascular reactivity. J Cardiovasc Pharmacol, 1999, 34(1): 95-101.
13. Bolotina V, Omelyanenko V, Heyes B, et al. Variations of membrane cholesterol alter the kinetics of Ca2+-dependent K+ channels and membrane fluidity in vascular smooth muscle cells. Pflugers Arch, 1989, 415(3): 262-268.
14. Engelmann M, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J, 2005, 26(20): 2083-2092.
15. Kumagai K, Nakashima H, Saku K. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting.
16. Hayashidani S, Tsutsui H, Shiomi T, et al. Fluvastatin, a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, attenuates left ventricular remodeling and failure after experimental myocardial infarction. Circulation, 2002,105 (7): 868-873.
17. Porter KE, Turner NA, 0’Regan DJ, et al. Simvastatin reduces human atrial myofibroblast proliferation independently of cholesterol lowering via inhibition of RhoA. Cardiovasc Res, 2004, 61(4): 745-755.
18. Shiroshita-Takeshita A, Schram G, Lavoie J, et al. Effect of simvastatin and antioxidant vitamins on atrial fibrillation promotion by atrial-tachycardia remodeling in dogs. Circulation, 2004, 110(16): 2313-2319.
19. Pliquett RU, Cormish KG, Peuler JD, et al. Simvastatin normalizes autonomic neural control in experimental heart failure. Circulation, 2003, 107(19): 2493-2498.
20. Welzig CM, Shin DG, Park HJ, et al. Lipid lowering by pravastatin increases parasympathetic modulation of heart rate: Galpha(i2), a possible molecular marker for parasympathetic responsiveness. Circulation, 2003, 108(22): 2743-2746.

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他汀類藥物治療心房顫動隨機對照試驗的Meta分析

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《中國循證醫學雜志》

他汀類藥物治療心房顫動隨機對照試驗的Meta分析

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