目的 評價阿托伐他汀治療心肌梗死后心力衰竭患者的有效性，為該病患者的循證治療提供證據(jù)。方法 計算機檢索PubMed、Cochrane圖書館、EMbase、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、萬方數(shù)據(jù)庫（Wanfang）、維普中文科技期刊數(shù)據(jù)庫（VIP）等數(shù)據(jù)庫中的隨機對照試驗（RCT），檢索時限均從建庫至2018年10月。采用RevMan 5.3軟件進行Meta-分析，客觀評價其臨床療效。結(jié)果 共納入22個RCTs，10 971例患者。對其中20個RCTs進行Meta-分析，結(jié)果顯示：（1）與常規(guī)治療組相比，阿托伐他汀組的左室射血分數(shù)（LVEF）、6 min步行距離明顯增加[MD=7.56，95% CI（4.13，10.98），P<0.000 1；MD=20.06，95% CI（9.77，30.35），P=0.000 1]，N末端腦鈉肽（NT-proBNP）、腦鈉肽（BNP）、左室舒張末期內(nèi)徑（LVEDD）、左室收縮末期內(nèi)徑（LVESD）值明顯減小[MD=-153.23，95% CI（-186.97，-119.49），P<0.00001；MD=-96.74，95% CI（-117.10，-76.38），P<0.00001；MD=-5.69，95% CI（-8.11，-3.27），P<0.000 01；MD=-6.80，95% CI（-8.65，-4.95），P<0.000 01]；（2）有7個研究涉及阿托伐他汀的劑量，與40 mg治療組相比20 mg治療組的LVEDD、LVESD、NT-proBNP、BNP明顯減少[MD=-5.13，95% CI（-6.05，-4.21），P<0.000 01；MD=-0.84，95% CI（-1.50，-0.17），P=0.01；MD=-26.53，95% CI（-47.68，-5.37），P=0.01；MD=-17.63，95% CI（-32.66，-2.59），P=0.02]，LVEF及6 min步行距離明顯增加[MD=9.13，95% CI（7.95，10.31），P<0.000 01；MD=22.24，95% CI（7.06，37.43），P=0.0004]。定性分析結(jié)果顯示阿托伐他汀可有效改善心肌梗死后心力衰竭的臨床癥狀及患者心功能狀況。結(jié)論 阿托伐他汀對心肌梗死后心力衰竭患者治療效果顯著，且可以有效預(yù)防無癥狀型心力衰竭進一步發(fā)展，但上述結(jié)論尚需更多大樣本高質(zhì)量的臨床試驗加以驗證。

Objective To evaluate the efficacy of attovastatin in the treatment of patients with heart failure after myocardial infarction, and to provide reliable evidence for evidence-based treatment of those patient. Methods The randomized controlled trial (RCT) were searched from PubMed, Cochrane Library, EMbase, CNKI, Wanfang, VIP and other databases. The time limit for retrieval is from the construction of the database to October 2018. This study was carried out with RevMan 5.3 software to evaluated its clinical efficacy objectively. Results A total of 22 RCTs were included, involving 10 971 patients. The results of Meta-analysis with 20 RCTs showed that:(1) Compared with the routine treatment group, the six-minute walking distance and the left ventricular ejection fraction (LVEF), in attovastatin group was significantly increased[MD=7.56, 95%CI(4.13, 10.98), P<0.0001; MD=20.06, 95%CI(9.77, 30.35), P=0.000 1]. And the N-terminal brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), left ventricular end-diastolic diameter (LVEDD), the left ventricular end systolic diameter (LVEDS) significantly decreased[MD=-153.23, 95%CI (-186.97, -119.49), P<0.000 01; MD=-96.74, 95%CI (-117.10, -76.38), P<0.000 01; MD=-5.69, 95%CI (-8.11, -3.27), P<0.000 01; MD=-6.80, 95%CI (-8.65, -4.95), P<0.000 01]. (2) Seven of the RCTs involved different doses of attovastatin showed the LVEDD, LVESD, NT-proBNP, BNP of 20 mg groups were significantly lower than those of 40 mg groups[MD=-5.13, 95%CI (-6.05, -4.21), P<0.000 01; MD=-0.84, 95%CI (-1.50, -0.17), P=0.01; MD=-26.53, 95%CI (-47.68, -5.37), P=0.01; MD=-17.63, 95%CI (-32.66, -2.59), P=0.02]; LVEF and six-minute walking distance was markedly increased[MD=9.13, 95%CI (7.95, 10.31), P<0.000 01; MD=22.24, 95%CI (7.06, 37.43), P=0.0004]. The results of qualitative analysis showed that attovastatin could effectively improve the clinical symptoms and cardiac function of patients with heart failure after myocardial infarction. Conclusion attovastatin is effective in the treatment of heart failure patients after myocardial infarction, which can effectively prevent the further development of asymptomatic heart failure. However, these conclusions need to be verified by more large samples and high quality clinical trials.

R954

國家重點研發(fā)計劃"中醫(yī)藥現(xiàn)代化研究"重點專項課題（2017YFC1700402）