普通球囊、裸金属支架、药物洗脱球囊及药物洗脱支架治疗膝下动脉闭塞症的网络Meta分析  

A network Meta-analysis of comparing balloon angioplasty, bare metal stent, drug-eluting balloon and drug-eluting stent for infrapopliteal artery occlusive lesions

作　　者：周阳 林少芒[1] 萧剑彬[1] 艾文佳[1] 李阳勇[1] 李强[1] 王俊伟[1] 李国林 叶智慧 张智辉[1] Zhou Yang;Lin Shaomang;Xiao Jianbin;Ai Wenjia;Li Yangyong;Li Qiang;Wang Junwei;Li Guolin;Ye Zhihui;Zhang Zhihui(Department of Vascular Surgery,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510220,China)

机构地区：[1]广州医科大学附属第二医院血管外科,广州510220

出　　处：《中华血管外科杂志》2019年第4期238-246,共9页Chinese Journal of Vascular Surgery

基　　金：广州医科大学博士科研基金项目(2013C48);广东省医学科研基金项目(A2012254).

摘　　要：目的探索普通球囊血管成形术(BA)、裸金属支架(BMS)、药物洗脱球囊(DEB)和药物洗脱支架(DES)4种方法治疗膝下动脉闭塞性病变疗效的差异.方法通过检索Medline、Embase数据库和Cochrane图书馆以寻找所有关于以上4种方法治疗膝下动脉硬化闭塞性病变的随机对照试验(RCT).采用Cochran偏移风险评估标准对入选RCT进行偏移风险评估.通过STATA 15统计软件以随机效应模型对入选RCT进行网络荟萃分析,采用预测区间图对以上4种方法在改善术后12个月的一期通畅率、靶病变血运重建率(TLR)、大截肢率以及死亡率的差异进行描述,采用累积排序曲线图(SUCRA)及排序概率图对4种方法改善以上四种结局指标的疗效进行排名.结果共纳入12篇RCT,1723例患者发现DES相比于BA和BMS有更高的一期通畅率,优势比(OR)分别为3.00和3.15,95%CI分别为1.19~7.58和1.23~8.08;还发现DEB相比于BA有更低的TLR(OR=0.40,95%CI 0.16~0.99).根据累积排序曲线的SUCRA值和排序概率,从一期通畅率(DES的SUCRA值85.3,最佳治疗概率59.1%)、TLR(DES的SUCRA值85.8,最佳治疗概率65.1%)和大截肢率(DES的SUCRA值94.6,最佳治疗概率86.7%)来看,DES被认为是改善一期通畅率、TLR和大截肢率最佳的治疗方法;DEB在改善一期通畅率和TLR方面要优于BA和BMS,但在改善大截肢率和死亡率方面,DEB被认为是效果最差的方法(DEB的SUCRA值分别为21.4和12.6).结论在膝下动脉闭塞性病变的治疗中,DES在改善一期通畅率、TLR和大截肢率方面具有明显的优势,DEB在改善一期通畅率和TLR方面可能优于BA和BMS,但在改善大截肢率和死亡率方面并无优势.Objective To explore the efficacy of balloon angioplasty(BA),bare metal stent(BMS),drug-eluting balloon(DEB)and drug-eluting stent(DES)for infrapopliteal artery occlusive disease.Methods Medline,Embase database and the Cochrane library were searched for all randomized controlled trials(RCTs)comparing the efficacy of the four treatments mentioned above.The Cochrane Collaboration's tool was used to assess the risk of bias of selected RCTs.STATA 15 was used to conduct network meta-analysis of selected RCTs with random effect model.Predictive interval plot was used to describe the differences between the four treatments in terms of primary patency,target lesion revascularization(TLR),major amputation and mortality at the 12-month follow-up.Surface under the cumulative ranking curve(SUCRA)and rank probability were used to rank the four treatments.Results A total of 12 studies,including 1723 patients,;were considered eligible.DES significantly increased primary patency compared to BA(OR=3.00,95%CI:1.19-7.58)and BMS(OR=3.15,95%CI:1.23-8.08).DEB significantly decreased TLR compared to BA(OR=0.40,95%CI:0.16-0.99).According to the value of SUCRA and ranking probability,DES was considered the best treatment in terms of primary patency(SUCRA value 85.3,probability of the best treatment 59.1%),TLR(SUCRA value 85.8,probability of the best treatment 65.1%)and major amputation(SUCRA value 94.6,probability of the best treatment 86.7%);DEB was considered better than BA and BMS in terms of primary patency and TLR,but it was considered the worst treatment in terms of major amputation and mortality(SUCRA value 21.4 and 12.6 respectively).Conclusions DES has obvious advantages in terms of primary patency,TLR and major amputation.DEB may be better than BA and BMS in improving primary patency and decreasing TLR,but it has no advantages in terms of major amputation and mortality.

关 键 词：普通球囊血管成形术 裸金属支架 药物洗脱支架 药物洗脱球囊 膝下动脉 网络荟萃分析 

分 类 号：R54[医药卫生—心血管疾病]