Meta-analysis of 10 mg policosanol versus an equal dose of atorvastatin on the lipid-lowering efficacy in patients with dyslipidemia
-
摘要: 目的 探讨比较10 mg多廿烷醇与等剂量阿托伐他汀在血脂异常患者中调脂的疗效。 方法 检索维普网（VIP）、万方数据库、中国知网（CNKI）以及Cochrance图书馆、美国国立医学图书馆（PubMed）、科学引文索引数据库（Web of Science）、荷兰医学文摘（EMBASE）等数据库，查找10 mg多廿烷醇和10 mg阿托伐他汀的随机对照试验（RCT）和临床对照试验（CCT），使用Cochrance Handbook 5.1.0评价系统或Newcastle-Ottawa量表（NOS）进行质量评价，采用RevMan5.2软件对纳入研究中的相关数据进行统计学分析。 结果 共纳入4篇RCT文献，受试者257例，其中10 mg多廿烷醇组130例，10 mg阿托伐他汀组127例。荟萃（Meta）分析结果显示，在降低总胆固醇（TC）[SMD=0.84，95%CI：（0.41，1.27），P=0.000 1]和低密度脂蛋白胆固醇（LDL-C）[SMD=0.68，95%CI：（0.28，1.09），P=0.001]方面，10 mg阿托伐他汀组均优于10 mg多廿烷醇组；在升高高密度脂蛋白胆固醇（HDL-C）[SMD=0.27，95%CI：（0.02，0.51），P=0.03]方面，10 mg多廿烷醇组优于10 mg阿托伐他汀组；在降低甘油三脂（TG）[SMD=0.10，95%CI：（-0.41，0.35），P=0.42]方面，两组无统计学差异。 结论 在血脂异常患者调脂治疗时，10 mg阿托伐他汀的疗效更优于等剂量的多廿烷醇，在替换阿托伐他汀治疗时应考虑增加多廿烷醇给药剂量，以保证调脂疗效。本研究存在纳入研究少、样本量小等局限性，结论的可靠性仍需多中心、大样本的高质量RCT研究加以验证。Abstract: Objective To evaluate the lipid-lowering effect of 10 mg policosanol versus an equal dose of atorvastatinin patients with dyslipidemia. Method Databases such as VIP,Wanfang,CNKI,Cochrance Library,PubMed,Web of Science and EMBASE were searched for random control trials(RCT) and controlled clinical trials (CCT) of 10 mg policosanol versus an equal dose of atorvastatinin their lipid-lowering effects. The quality was assessed by Cochrance Handbook 5.1.0 or Newcastle-Ottawa scale (NOS).The study related data were analyzed statistically with RevMan 5.2 software.4 RCTs were selected. 257 patients were included in the trials. 130 cases were in 10 mg policosanol group and 127 cases belonged to 10 mg atorvastatin group. Results Results of Meta-analysis show that TC[SMD=0.84,95%CI(0.41,1.27),P=0.000 1] and LDL-C[SMD=0.68,95%CI(0.28,1.09),P=0.001] were reduced more effectively in 10 mg atorvastatin group than in 10 mg policosanol group.HDL-C[SMD=0.27,95%CI(0.02,0.51),P=0.03] was elevated more in 10 mg policosanol group than 10 mg atorvastatin group.Both groups showed no statistic difference(P=0.42) in TG [SMD=0.10,95% CI:(-0.41,0.35),P=0.42]. Conclusion The lipid-lowering efficacy of 10 mg atorvastatin is better than equal dose of policosanolin patients with dyslipidemia. Dose increase of policosanol should be considered to ensure the efficacy when policosanol was used tore place atorvastatin therapy. This study had some shortcomings, such as limited study numbers and small sample size. The reliability of this study should be verified from high-quality,multi-center RCTS with large samples.
-
Key words:
- policosanol /
- atorvastatin /
- equaldose /
- lipid-lowering efficacy /
- Meta-analysis
-
[1] 崔艳丽,赵秀丽,武 峰,等.胆固醇酯转运蛋白基因TaqⅠ多态性与多廿烷醇降脂疗效的关系[J].中国新药杂志,2007,16(3):240-243. [2] Menendez R,Marrero D,Mas R,et al.In vitro and in vivo study of octacosanol metabolism[J].Arch Med Res,2005,36(2):113-119. [3] Menéndez R,Fraga V,Amor AM,et al.Oral administration of policosanol inhibits in vitro copper ion-induced rat lipoprotein peroxidation[J].Physiol Behav,1999,67(1):1-7. [4] 多廿烷醇临床应用专家共识组.新型调脂植物药——多廿烷醇临床应用专家共识[J].中华内科杂志,2008,11(47):961-963. [5] Menendez R,Amor AM,Rodeiro I,et al.Policosanol modulates HMG-CoA reductase activity in cultured fibroblasts[J].Arch Med Res,2001,32(1):8-12. [6] Singh DK,Li L,Porter TD.Policosanol inhibits cholesterol synthesis in hepatoma cells by activation of AMP-kinase[J].J Pharmacol Exp Ther, 2006,318(3):1020-1026. [7] 中华心血管杂志编委会心血管药物对策专题组.心血管药物临床试验评价方法的建议[J].中华心血管病杂志,1998,26(1):5-11. [8] 申 琳,崔 君.多廿烷醇和瑞舒伐他汀治疗老年高脂血症的成本-效果分析[J].临床误诊误治,2011,24(10):87-89. [9] 丁 宇,司全金.多廿烷醇在老年心血管病患者调脂治疗中的有效性及安全性分析[J].中华老年心脑血管病杂志,2015,17(6):575-579. [10] Castaño G,Fernández L, Mas R,et al.Comparison ofthe effects of policosanol and atorva-statinon lipid profile and platelet aggregation in patients with dyslipidaemia and type 2 diabetes mellitus[J].Clin Drug Investig,2003,23(10):639-650. [11] Castaño G,Mas R,Fernández L,et al.Comparison of the efficacy and tolerability of policosanol withatorvastatin in elderly patients with type Ⅱ hypercholesterolaemia[J].Drugs Aging,2003,20(2):153-163. [12] Castaño G,Illnait J,Fernández L,et al.Comparison of the effects of policosanol and atorvastatin on postmenopausal women with type Ⅱ hypercholesterolemia[J].Revista Cenic Ciencias Biológicas, 2008,39(1):27-32. [13] 孙 静,武 强,龙 梅.多廿烷醇与阿托伐他汀治疗高脂血症的疗效对比[J].军医进修学院学报,2011,32(10):1023-1024,1029. [14] 郑明华,施可庆,张天嵩,等.Meta分析软件应用与实例解析[M].北京:人民卫生出版社,2013:78. [15] 李 莹,陈志红,周北凡,等.血脂和脂蛋白水平对我国中年人群缺血性心血管病事件的预测作用[J].中华心血管病杂志.2004,32(7):643-647. [16] 蔡德山.浅析天然调血脂药物"多廿烷醇" [J].中国制药信息,2014,30(10):10-14. [17] 徐同成,李 霞,王文亮,等.分类变量Meta分析中偏倚的检测-Egger法和Begg法[J].循证医学,2009,3:181-184. [18] 魏丽娟,董惠娟.Meta分析中异质性的识别与处理[J].第二军医大学学报,2006,27(4):449-450. -
点击查看大图
计量
- 文章访问数: 3219
- HTML全文浏览量: 359
- PDF下载量: 988
- 被引次数: 0
下载:
