作者：李洁，李俊，杨玉亚，朱春香，杨芸，范伟伟，张海燕

单位：

213000 江苏省常州市，江苏大学附属武进医院药事科；通信作者：张海燕，E-mail：1669332803@qq.com

Units：

Department of Pharmacy，Wujin Hospital Affiliated to Jiangsu University，Changzhou 213000，China；Corresponding author：ZHANG Haiyan，E-mail：1669332803@qq.com

关键词：

血糖；血脂异常；匹伐他汀；阿托伐他汀；Meta 分析

Keywords：

Blood glucose；Dyslipidemias；Pitavastatin；Atorvastatin；Meta-analysis

CLC：

R 446.112　R 589

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.007

Funds：

摘要：

目的　比较匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标的影响。方法　计算机检索 EMBase、PubMed、The Cochrane Library、万方数据知识服务平台、中国知网和维普网，检索时间为建库至2018年12月，筛选关于匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标影响的随机对照试验（RCT），其中采用匹伐他汀治疗者作为 PTV 组，采用阿托伐他汀治疗者作为 AVT 组。采用 RevMan 5.3 软件进行 Meta 分析，比较两组患者治疗后血脂指标〔包括总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）〕、血糖指标〔包括空腹血糖（FBG）、糖化血红蛋白（HbA 1c ）〕。结果　最终纳入 14 篇文献，共 1 067 例患者。Meta 分析结果显示，治疗后 PVT 组患者 TC〔MD=1.18，95%CI（0.37，1.99）〕、HDL-C〔MD=0.12，95%CI（0.03，0.22）〕 高 于 AVT 组，FBG〔MD=-0.71，95%CI（-1.06，0.36）〕、HbA 1c 〔MD=-0.34，95%CI（-0.53，-0.15）〕低于 AVT 组（P<0.05）；两组患者治疗后 TG〔MD=0.04，95%CI（-0.03，0.11）〕、LDL-C〔MD=-0.00，95%CI（-0.08，0.07）〕比较，差异无统计学意义（P>0.05）。绘制报道 HbA 1c 文献发表偏倚的倒漏斗图发现，分布于直线两侧的散点不对称，提示可能存在发表偏倚；绘制报道 TG 文献发表偏倚的倒漏斗图发现，分布于直线两侧的散点对称，提示无发表偏倚。结论　现有文献证据表明，匹伐他汀与阿托伐汀对冠状动脉疾病、血脂异常、糖耐量异常患者 TG、LDL-C 的影响相似，而与阿托伐他汀相比，匹伐他汀能更有效地降低患者 FBG、HbA 1c ，升高患者 HDL-C，但降低患者 TC 的效果不如阿托伐他汀。

Abstract：

Objective　To compare the impact on blood lipid parameters and blood glucose related index betweenpitavastatin and atorvastatin in patients with coronary artery disease，dyslipidemia or impaired glucose tolerance. MethodsComputer was used to search EMBase，PubMed，The Cochrane Library，Wanfang Data，CNKI and VIP from building databaseto December 2018，to screen RCTs about impact on blood lipid parameters and blood glucose related index between pitavastatinand atorvastatin in patients with coronary artery disease，dyslipidemia or impaired glucose tolerance，thereinto patients treatedby pitavastatin were served as PTV group，the other patients treated by atorvastatin were served as AVT group. Meta-analysiswas carried out by RevMan 5.3 software. Blood lipid parameters（including TC，TG，LDL-C and HDL-C）and blood glucoserelated index（including FBG and HbA 1c ）were compared between the two groups after treatment. Results　A total of 14literatures were enrolled eventually，including 1，067 patients. Meta-analysis results showed that，TC〔MD=1.18，95%CI （0.37，1.99）〕and HDL-C〔MD=0.12，95%CI（0.03，0.22）〕in PTV group were statistically significantly higher than thosein ATV group after treatment（P<0.05），while FBG〔MD=-0.71，95%CI（-1.06，0.36）〕and HbA 1c 〔MD=-0.34，95%CI（-0.53，-0.15）〕in PTV group were statistically significantly lower than those in ATV group（P<0.05）；there wasno statistically significant difference in TG〔MD=0.04，95%CI （-0.03，0.11）〕 or LDL-C〔MD=-0.00，95%CI （-0.08，0.07）〕between the two groups after treatment（P>0.05）. Inverted funnel plot for publication bias of literatures reported HbA 1c showedthat，the scattered points on both sides of the line were asymmetric，indicating existence of publication bias；inverted funnelplot for publication bias of literatures reported TG showed that，the scattered points on both sides of the line were symmetric，thus there was no publication bias. Conclusion　Available literature evidence suggests that，pitavastatin and atorvastatin havesimilar impact on TG and LDL-C in patients with coronary artery disease，dyslipidemia or impaired glucose tolerance，andcompared with atorvastatin，pitavastatin can more effectively reduce FBG and HbA 1c ，as well as increase HDL-C，but not asgood as atorvastatin in lowing TC.

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