评估阿托伐他汀治疗无需手术的慢性硬膜下血肿的效果:随机对照试验的元分析

Bo Wang, Kangqi Li, Chenyu Guo, Zhe Wang, Weiwei Zhu, Congxiao Lu
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摘要

慢性硬膜下血肿(CSDH)是蛛网膜和硬脑膜之间血液积聚形成的慢性占位性病变。阿托伐他汀治疗慢性硬膜下血肿越来越受到临床关注。我们对已发表的随机对照试验(RCT)进行了荟萃分析,以客观数据为主要结果,对阿托伐他汀治疗CSDH的疗效进行了循证分析。系统检索了MEDLINE(通过PubMed)、EMBASE、Cochrane图书馆、Scopus、Web of Science、ScienceDirect、中国国家知识基础设施(CNKI)、Cqvip数据库(CQVIP)和万方数据库等数据库中报告阿托伐他汀治疗CSDH的RCT。研究采用了比值比 (OR)、标准平均差 (SMD) 和 95% 置信区间 (CI) 作为汇总统计。为评估研究异质性对荟萃分析结果的影响,进行了I-square(I 2)检验。本次荟萃分析共纳入了九项相关研究,611 名患者。与对照组相比,阿托伐他汀治疗的有效率明显更高(OR:7.41,95% CI:3.32-16.52,P < 0.00001,I 2 = 0%),血肿体积更小(SMD:-0.46,95% CI:-0.71--0.20,P = 0.0005,I 2 = 0%)、更高的日常生活活动-巴特尔指数(ADL-BI)(SMD:2.07,95% CI:1.06-3.09,P < 0.0001,I 2 = 92%)和更小的中国卒中量表(CSS)(SMD:-1.10,95% CI:-1.72 至 -0.48,P = 0.0005,I 2 = 57%)。鉴于这些研究结果,我们得出结论:基于九项研究,611 名患者,实验组在有效性、血肿量、ADL-BI 和 CSS 方面优于对照组。阿托伐他汀对未进行手术的 CSDH 患者有益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of Effectiveness of Atorvastatin in Treating Chronic Subdural Hematoma not Requiring Surgery: A Meta-Analysis of Randomized Controlled Trials
Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between the arachnoid membrane and the dura mater. Atorvastatin is of increasing clinical interest for CSDH. We performed a meta-analysis of published randomized controlled trials (RCTs) and used objective data as the primary outcomes to provide an evidence-based analysis of the efficacy of atorvastatin for CSDH treatment. Databases of MEDLINE (via PubMed), EMBASE, the Cochrane Library, Scopus, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure (CNKI), Cqvip database (CQVIP), and Wanfang database were systematically searched for RCTs reporting the use of atorvastatin for CSDH treatment. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used as summary statistics. I-square (I 2) test was performed to assess the impact of study heterogeneity on the results of the meta-analysis. Nine relevant RCTs with 611 patients were identified for inclusion in this meta-analysis. Compared to controls, atorvastatin treatment had a significantly higher effectiveness (OR: 7.41, 95% CI: 3.32-16.52, P < 0.00001, I 2 = 0%), lower hematoma volume (SMD: −0.46. 95% CI: −0.71 to −0.20, P = 0.0005, I 2 = 0%), higher activities of daily living-Barthel Index (ADL-BI) (SMD: 2.07, 95% CI: 1.06-3.09, P < 0.0001, I 2 = 92%), and smaller Chinese stroke scale (CSS) (SMD: -1.10, 95% CI: −1.72 to −0.48, P = 0.0005, I 2 = 57%). In view of these findings, we conclude that the outcomes of experimental group are superior to the control group with respect to effectiveness, hematoma volume, ADL-BI, and CSS based on nine RCTs with 611 patients. Atorvastatin is beneficial to CSDH patients without surgery.
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