接受别嘌醇治疗的痛风成人发生心肌梗死的风险：一项系统评价与荟萃分析。
完整摘要 · 中文译文
目的 尽管别嘌醇用于降尿酸治疗，但其对心肌梗死风险的影响仍不明确。本研究评估了痛风成人中使用别嘌醇与心肌梗死发生风险之间的关联。 方法 在PROSPERO注册（CRD420261305257）后，进行了系统评价和Meta分析。检索了PubMed、Scopus和Web of Science，时间从建库至2026年1月。纳入已确诊痛风的成人观察性研究，这些研究报告了心肌梗死的校正风险比（HRs），并单独明确了别嘌醇暴露。采用Paule-Mandel估计量的逆方差随机效应模型计算合并估计值。通过留一法、主动比较剂和Hartung-Knapp敏感性分析评估稳健性。 结果 四项回顾性队列研究符合修订后的纳入标准。在主要随机效应分析中，别嘌醇使用与较低的心肌梗死风险相关（HR 0.84；95% CI 0.76-0.94；I2 = 0%）。然而，在排除权重最大的研究后（HR 1.04；95% CI 0.79-1.36）、限制于主动比较剂时（HR 1.04；95% CI 0.79-1.36）或使用Hartung-Knapp校正后（HR 0.84；95% CI 0.71-1.00），该关联不具有统计学显著性。 结论 在痛风成人中，别嘌醇治疗与心肌梗死风险的适度但显著降低相关。
完整摘要 · 英文原文
AimsAlthough allopurinol is used for urate-lowering therapy, its effect on myocardial infarction risk remains unclear. This study assessed the association between allopurinol use and myocardial infarction in adults with gout.MethodsA systematic review and meta-analysis was conducted following PROSPERO registration (CRD420261305257). PubMed, Scopus, and Web of Science were searched from inception to January 2026. Observational studies of adults with confirmed gout that reported adjusted hazard ratios (HRs) for myocardial infarction and separately identifiable allopurinol exposure were included. Pooled estimates were calculated using an inverse-variance random-effects model with the Paule-Mandel estimator. Robustness was assessed through leave-one-out, active-comparator, and Hartung-Knapp sensitivity analyses.ResultsFour retrospective cohort studies met the revised eligibility criteria. In the primary random-effects analysis, allopurinol use was associated with a lower risk of myocardial infarction (HR 0.84; 95% CI 0.76-0.94; I2 = 0%). However, the association was not statistically significant after excluding the study contributing the greatest weight (HR 1.04; 95% CI 0.79-1.36), when restricted to active comparators (HR 1.04; 95% CI 0.79-1.36), or using the Hartung-Knapp adjustment (HR 0.84; 95% CI 0.71-1.00).ConclusionAllopurinol therapy was associated with a modest but significant reduction in myocardial infarction risk in adults with gout.