背景:代谢综合征(MetS)的特征是肥胖的共存,胰岛素抵抗,血脂异常,和高血压。红曲米(RYR)制剂可能有助于预防和治疗MetS。目的:进行系统评价和荟萃分析,以确定RYR制剂是否可以改善临床终点并减少MetS的危险因素。方法:PubMed,科克伦图书馆,EMBASE,Scopus,中国国家知识基础设施,中文VIP信息,并在万方数据库中搜索随机对照试验(截至2020年9月发布),使用固定或随机效应模型进行荟萃分析.主要结局指标为死亡率和主要不良心血管事件(MACEs)。次要结果指标是血糖生化参数,血脂,还有血压.注册号为CRD42020209186。结果:共鉴定出921篇文献,其中30篇文章包含在本文中。与对照组相比,RYR制剂组表现出MetS的显着改善。RYR制剂降低了死亡率和MACE(RR=0.62,95%CI[0.49,0.78];RR=0.54,95%CI[0.43,0.66])。在血糖代谢方面,空腹血糖(FPG)(MD=-0.46mmol/L,95%CI[-0.71,-0.22]),血红蛋白A1c(HbA1c)(MD=-0.49,95%CI[-0.71,-0.26])和胰岛素抵抗的稳态模型评估(HOMA-IR)(MD=-0.93,95%CI[-1.64,-0.21])降低.关于脂质代谢,总胆固醇(TC)(MD=-0.74mmol/L,95%CI[-1.02,-0.46]),甘油三酯(TG)(MD=-0.45mmol/L,95%CI[-0.70,-0.21]),和低密度脂蛋白胆固醇(LDL)(MD=-0.42mmol/L,95%CI[-0.78,-0.06])下降,而高密度脂蛋白胆固醇(HDL)(MD=0.14mmol/L,95%CI[0.09,0.20])增加。关于血压,平均动脉压(MAP)(MD=-3.79mmHg,95%CI[-5.01,-2.57])降低。此外,RYR制剂没有增加不良反应的发生率(RR=1.00,95%CI[0.69,1.43])。结论:RYR制剂降低死亡率,MACEs,以及MetS的多种风险因素,而不影响安全性,支持其在预防和治疗MetS中的应用。然而,由于本研究的异质性,需要更多高质量的研究来提供更多证据证明RYR对MetS的影响.系统审查注册:www。crd.约克。AC.英国/PROSPERO,标识符CRD42020209186。
Background: Metabolic syndrome (MetS) is characterized by the cooccurrence of obesity, insulin resistance, dyslipidaemia, and hypertension. Red yeast rice (RYR) preparations might be beneficial for the prevention and treatment of MetS. Objective: To implement a systematic
review and meta-analysis to determine whether RYR preparations improve clinical endpoints and reduce risk factors for MetS. Methods: The PubMed, Cochrane Library, EMBASE, Scopus, China National Knowledge Infrastructure, Chinese VIP Information, and WanFang databases were searched for randomized controlled trials (published up to September 2020), and a meta-analysis was performed using fixed- or random-effects models. The primary outcome measures were mortality and major adverse cardiovascular events (MACEs), and the secondary outcome measures were biochemical parameters of blood glucose, blood lipids, and blood pressure. The registration number is CRD42020209186. Results: A total of 921 articles were identified, of which 30 articles were included in this article. RYR preparations group demonstrated significant improvements in MetS compared with control group. RYR preparations reduced the mortality and MACEs (RR = 0.62, 95% CI [0.49, 0.78]; RR = 0.54, 95% CI [0.43, 0.66]). In terms of blood glucose metabolism, fasting plasma glucose (FPG) (MD = -0.46 mmol/L, 95% CI [-0.71, -0.22]), haemoglobin A1c (HbA1c) (MD = -0.49, 95% CI [-0.71, -0.26]) and the homeostasis model assessment of insulin resistance (HOMA-IR) (MD = -0.93, 95% CI [-1.64, -0.21]) were decreased. Regarding the lipid metabolism, total cholesterol (TC) (MD = -0.74 mmol/L, 95% CI [-1.02, -0.46]), triglycerides (TG) (MD = -0.45 mmol/L, 95% CI [-0.70, -0.21]), and low-density lipoprotein cholesterol (LDL) (MD = -0.42 mmol/L, 95% CI [-0.78, -0.06]) were decreased, while high-density lipoprotein cholesterol (HDL) (MD = 0.14 mmol/L, 95% CI [0.09, 0.20]) was increased. Regarding blood pressure, the mean arterial pressure (MAP) (MD = -3.79 mmHg, 95% CI [-5.01, -2.57]) was decreased. In addition, RYR preparations did not increase the incidence of adverse reactions (RR = 1.00, 95% CI [0.69, 1.43]). Conclusion: RYR preparations reduce mortality, MACEs, and multiple risk factors for MetS without compromising safety, which supports its application for the prevention and treatment of MetS. However, additional high-quality studies are needed to provide more evidence for the effect of RYR on MetS due to the heterogeneity in this study. Systematic
Review Registration: www.crd.york.ac.uk/PROSPERO, identifier CRD42020209186.