摘要
目的:系统评价不同抗炎药物治疗冠心病的有效性和安全性,以进一步明确冠心病抗炎治疗的理想靶点。方法:计算机检索MedLine、the Cochrane Library、EMbase、Web of Science等数据库,检索抗炎药物治疗冠心病的随机对照试验。使用RevMan 5.3软件对纳入文献进行Meta分析。结果:纳入18篇文献,涉及65892例病人,Meta分析结果显示,接受抗炎治疗的病人发生主要不良心血管事件(MACE)的风险较低[RR=0.87,95%CI(0.79,0.96),P=0.005],亚组分析提示,白细胞介素(IL)-1拮抗剂[RR=0.87,95%CI(0.79,0.95),P=0.002]及秋水仙碱[RR=0.61,95%CI(0.48,0.79),P=0.0001]降低了病人MACE发生风险,差异有统计学意义。抗炎药物对病人全因死亡率没有影响。两组因心力衰竭再住院发生率比较,差异无统计学意义[RR=0.95,95%CI(0.83,1.10),P>0.05],亚组分析提示,IL-1拮抗剂降低了冠心病病人因心力衰竭再住院发生率[RR=0.12,95%CI(0.02,0.94),P=0.04]。不良反应方面,甲氨蝶呤增加了病人感染的风险[RR=1.13,95%CI(1.03,1.24),P=0.01]以及胃肠道不良反应的发生风险[RR=1.23,95%CI(1.07,1.43),P<0.05]。结论:现有证据表明,抗炎治疗能够减少冠心病病人MACE的发生,而核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)/IL-1/IL-6炎症通路可作为理想的治疗靶点之一。
Objective:To systematically evaluate the efficacy and safety of different anti-inflammatory drugs for the treatment of coronary heart disease,in order to further clarify the optimal targets of anti-inflammatory treatment of coronary heart disease.Methods:Randomized controlled trials of anti-inflammatory drugs for coronary heart disease were searched from MedLine,the Cochrane Library,EMbase,Web of Science and other databases.RevMan 5.3 software were used for Meta-analysis.Results:A total of 18 literatures were included,including 65892 patients.The results of Meta-analysis showed that anti-inflammatory therapy patients occurred a low risk of major adverse cardiovascular events(MACE)(RR=0.87,95%CI 0.79-0.96,P=0.005),the subgroup analysis showed that interleukin(IL)1 antagonist(RR=0.87,95%CI 0.79-0.95,P=0.002)and colchicine reduced the risk of MACE(RR=0.61,95%CI 0.48-0.79,P=0.0001).Anti-inflammatory drugs showed no effect on all-cause mortality.There was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups(RR=0.95,95%CI 0.83-1.10,P>0.05).Subgroup analysis showed that IL-1 antagonists reduced the incidence of hospitalization due to heart failure in coronary heart disease patients(RR=0.12,95%CI 0.02-0.94,P=0.04).In terms of adverse reactions,methotrexate increased the risk of infection(RR=1.13,95%CI 1.03-1.24,P=0.01)and gastrointestinal adverse reactions(RR=1.23,95%CI 1.07-1.43,P<0.05).Conclusion:The current evidence showed that anti-inflammatory therapy could reduce the incidence of MACE in patients with coronary heart disease,and the nucleotide-binding oligomeric domain-like receptor protein 3(NLRP3)/IL-1/IL-6 inflammatory pathway might be one of the ideal therapeutic targets.
作者
刘学谦
范丽花
陈赟虎
陈道鹏
任翔
LIU Xueqian;FAN Lihua;CHEN Yunhu;CHEN Daopeng;REN Xiang(Taicang Affiliated Hospital of Nanjing University of Chinese Medicine/Taicang Hospital of Traditional Chinese Medicine,Taicang 215400,Jiangsu,China)
出处
《中西医结合心脑血管病杂志》
2024年第15期2799-2807,共9页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
国家自然科学基金项目(No.82305126)
江苏省中西医结合学会青年科技人才托举工程(No.JSZXTJ-2024-B04)
苏州市科技发展计划项目(No.SKYD2022059)
太仓市基础研究计划项目(No.TC2023JCYL03,TC2021JCYL05)。
关键词
冠心病
抗炎药物
主要不良心血管事件
META分析
系统评价
coronary heart disease
anti-inflammatory drugs
major adverse cardiovascular events
Meta-analysis
systematic review
