探究不同他汀类药物治疗高脂血症的影响：基于网状Meta分析和多变量孟德尔随机化研究
Exploring the Effects of Different Statins in the Treatment of Hyperlipidemia: A Reticular Meta-Analysis and Multivariate Mendelian Randomization Study
摘要: 目的：探究不同他汀类药物治疗高脂血症的疗效和对人体不良反应的影响。方法：本次研究联合使用了网状Meta分析和多变量孟德尔随机化研究方法，对瑞舒伐他汀、阿托伐他汀、普伐他汀、辛伐他汀，4种他汀类药物治疗高脂血症临床疗效及不良反应症状进行了研究分析。结果：基于临床数据的网状Meta分析研究显示：① 治疗总胆固醇(TC)疗效排序：瑞舒伐他汀 > 阿托伐他汀 > 辛伐他汀 > 普伐他汀；② 治疗低密度脂蛋白胆固醇(LDL-C)疗效排序：瑞舒伐他汀 > 阿托伐他汀 > 普伐他汀 > 辛伐他汀；③ 治疗甘油三脂(TG)疗效排序：瑞舒伐他汀 > 阿托伐他汀 > 普伐他汀 > 辛伐他汀；④ 治疗高密度脂蛋白胆固醇(HDL-C)疗效排序：瑞舒伐他汀 > 阿托伐他汀 > 辛伐他汀 > 普伐他汀。基于基因组数据的多变量孟德尔随机化研究显示：① 高血压：阿托伐他汀具有增加高血压的潜在风险，普伐他汀与高血压的风险降低有关，但显著性均不高；瑞舒伐他汀与高血压的风险降低有关，辛伐他汀的使用与高血压的风险增加有关，且显著性相关。② 糖尿病：阿托伐他汀、瑞舒伐他汀与糖尿病的风险降低有关，普伐他汀与糖尿病的风险增加有关，但显著性均不高；辛伐他汀与糖尿病的风险增加有关，显著性相关。③ 瑞舒伐他汀、阿托伐他汀、辛伐他汀、普伐他汀与便秘的风险增加有关，但显著性均不高。结论：瑞舒伐他汀在调节血浆中低密度脂蛋白胆固醇、甘油三酯、胆固醇、高密度脂蛋白胆固醇较其他他汀类药物疗效最优，并且治疗时患有高血压、糖尿病、便秘的不良反应风险可能较其他他汀类药物低。
Abstract: Objective: To explore the efficacy of different statins in the treatment of hyperlipidemia and their effects on adverse reactions in humans. Methods: This study combined with reticular meta-analysis and multivariable Mendelian randomization research method to study and analyze the clinical efficacy and adverse reaction symptoms of rosuvastatin, atorvastatin, pravastatin, simvastatin, and four statins in the treatment of hyperlipidemia and their symptoms. Results: A reticular meta-analysis study based on clinical data showed that: ① The efficacy ranking of total cholesterol (TC) treatment: rosuvastatin > atorvastatin > simvastatin > pravastatin; ② The efficacy ranking of low-density lipoprotein cholesterol (LDL-C) treatment: rosuvastatin > atorvastatin > pravastatin > simvastatin; ③ The efficacy ranking of triglycerides (TG) treatment: rosuvastatin > atorvastatin > pravastatin > simvastatin; ④ The efficacy ranking of high-density lipoprotein cholesterol (HDL-C) treatment: rosuvastatin > atorvastatin > simvastatin > pravastatin. Multivariable Mendelian randomization study based on genomic data shows: ① Hypertension: atorvastatin has the potential risk of increasing hypertension, and pravastatin is related to the reduced risk of hypertension, but the significance is not high; rosuvastatin is related to the reduced risk of hypertension, and the use of simvastatin is related to the increased risk of hypertension, and it is significantly related. ② Diabetes: Atorvastatin and rosuvastatin are related to the reduced risk of diabetes, and pravastatin is related to the increased risk of diabetes, but the significance is not high; simvastatin is related to the increased risk of diabetes, and is significantly related. ③ Rosuvastatin, atorvastatin, simvastatin, and pravastatin are associated with an increased risk of constipation, but their significance is not high. Conclusions: Rosuvastatin is the most effective in regulating low-density lipoprotein cholesterol, triglycerides, cholesterol and high-density lipoprotein cholesterol in plasma, and the risk of adverse reactions of hypertension, diabetes, and constipation during treatment is lower than that of other statins.
文章引用：刘凯, 王磊, 杨玉林, 吴燕, 成安勇, 孙甫. 探究不同他汀类药物治疗高脂血症的影响：基于网状Meta分析和多变量孟德尔随机化研究[J]. 临床医学进展, 2025, 15(10): 363-378. https://doi.org/10.12677/acm.2025.15102766

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