他汀类药物与抗生素之间的药物相互作用：观察性研究的系统评价与荟萃分析。
完整摘要 · 中文译文
他汀类药物常被用于预防心血管疾病。某些抗生素，尤其是大环内酯类，可增加与肌肉相关副作用的风险并抑制他汀类药物的代谢。尽管结果不一，来自独立观察性研究的证据提示，当这些药物联合使用时，他汀相关肌肉毒性可能增加。通过开展系统评价和观察性数据的定量合成，评估与相互作用的抗生素联用相较于单用他汀治疗是否会增加他汀相关肌肉毒性的风险。在多个数据库中进行了系统性文献检索。纳入报告联用抗生素时他汀相关肌病或横纹肌溶解症风险估计值的观察性研究。独立提取数据并计算合并比值比（ORs）。由于结局罕见，相对风险被视为ORs的近似值。采用留一法进行敏感性分析。该meta分析纳入了三项符合纳入标准的观察性研究。他汀与相互作用的抗生素联用与肌肉毒性风险显著升高相关。合并OR为2.13，95%置信区间为1.82-2.50。敏感性分析显示结果稳健，因为排除单个研究时合并估计值未发生变化。与相互作用的抗生素和他汀类药物联用与statin-ass风险增加相关 相关的肌肉毒性。临床医生在开具此类联合用药处方时应谨慎，尤其是在高危患者中。需要进一步开展大规模研究，以更好地量化不同他汀类药物和抗生素类别之间的风险。
完整摘要 · 英文原文
Statins are frequently prescribed for the prevention of cardiovascular diseases. Certain antibiotics, especially macrolides, can raise the risk of side effects related to muscles and inhibit the metabolism of statins. Although results have been mixed, evidence from separate observational studies has pointed to a potential rise in statin-associated muscle toxicity when these drugs are used together. To evaluate whether the concurrent use of interacting antibiotics raises the risk of statin-associated muscle toxicity in comparison to statin therapy alone by conducting a systematic review and quantitative synthesis of observational data. A systematic literature search was conducted in various databases. Observational studies reporting risk estimates for statin-associated myopathy or rhabdomyolysis with concomitant antibiotic use were included. Data were extracted independently and pooled odds ratios (ORs) were calculated. Relative risks were treated as approximations of ORs due to the rarity of outcomes. Sensitivity analysis was performed using a leave-one-out approach. The meta-analysis included three observational studies that met the inclusion criteria. A markedly elevated risk of muscle toxicity was linked to the concurrent use of statins and interacting antibiotics. With a 95% confidence interval of 1.82-2.50, the pooled OR was 2.13. Sensitivity analysis showed that the results were robust since the pooled estimate did not change when individual studies were excluded. Concurrent use of interacting antibiotics with statins is associated with an increased risk of statin-associated muscle toxicity. Clinicians should exercise caution when prescribing such combinations, particularly in high-risk patients. Further large-scale studies are needed to better quantify risk across different statins and antibiotic classes.