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目的系统评价经皮冠状动脉介入术(PCI)术前使用他汀治疗预防围手术期冠心病患者心肌梗死的有效性。方法计算机检索CNKI、CBM、MEDLINE和e Cochrane Library,收集PCI术前他汀治疗对心血管事件影响的随机对照试验,检索时限均从1990年1月至2011年5月。由2位评价者按照纳入和排除标准筛选文献、提取资料并进行方法学质量评价,然后采用RevMan 5.0软件进行Meta分析。结果最终纳入10个随机对照试验,共3 012例冠心病患者。Meta分析结果显示:在围手术期,对照组1 498例中有207例发生心肌梗死,他汀治疗组1 514例中有98例发生心肌梗死,两组差异有统计学意义[OR=0.43,95%CI(0.34,0.56),P<0.000 01];对照组有226例发生主要心脏不良事件,他汀治疗组103例发生主要心脏不良事件,两组差异有统计学意义[OR=0.41,95%CI(0.32,0.53),P<0.000 01]。结论与安慰剂治疗相比,PCI术前应用他汀类药物可明显降低围手术期冠心病患者心肌梗死发生率和主要心脏不良事件。受纳入研究数量和质量所限,上述结论尚需开展更多高质量大样本研究验证。
Objective To evaluate the effectiveness of percutaneous coronary intervention (PCI) for the prevention of myocardial infarction in patients with perioperative coronary artery disease. Methods CNKI, CBM, MEDLINE and eCochrane Library were retrieved by computer. Randomized controlled trials of statin therapy before PCI on cardiovascular events were collected. The search time ranged from January 1990 to May 2011. Two reviewers screened the literature according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality, and then used Meta-analysis with RevMan 5.0 software. Results Finally included 10 randomized controlled trials, a total of 3 012 patients with coronary heart disease. In the perioperative period, there were 207 myocardial infarctions in 1 498 patients in the control group and 98 in 1 514 patients in the statin group, with a significant difference between the two groups (OR = 0.43, 95 % CI (0.34,0.56), P <0.000 01]. There were 226 major adverse cardiac events in the control group and 103 major adverse cardiac events in the statin group, with significant differences between the two groups (OR = 0.41, 95% CI (0.32, 0.53), P <0.000 01]. Conclusions Compared with placebo, statin therapy before PCI can significantly reduce the incidence of myocardial infarction and major adverse cardiac events in patients with perioperative coronary artery disease. Due to the limited number and quality of the studies involved, more conclusions need to be drawn from more high-quality large sample studies.