冠脉旁路移植术后心肌损伤标记物对术后死亡率影响的Meta分析  

Influence of Myocardial Injury Markers on the Mortality after Coronary Artery Bypass Grafting:A Meta-Analysis

作　　者：李瑾[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐市830054

出　　处：《中国循证医学杂志》2012年第7期777-784,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价冠脉旁路移植术术后心肌损伤标记物对术后短期、长期死亡率的影响。方法计算机检索Cochrane Library、PubMed、EMbase、Ovid、CNKI、VIP、WanFang Data,检索时间均从建库至2011年8月,手工检索相关杂志并追索纳入文献的参考文献。纳入冠脉旁路移植术后心肌损伤标记物[肌酸激酶同工酶(CK-MB)和肌钙蛋白I(cTnI)]对术后死亡率影响的队列和病例对照研究,由两位评价员按照纳入排除标准独立进行资料提取、质量评价并交叉核对后,采用RevMan 5.0软件进行Meta分析。结果纳入10个队列研究,共10 793例患者。Meta分析结果显示:无论体外循环冠脉搭桥术(on-pump)或非体外循环冠脉搭桥术(o pump),CK-MB增高组术后短期死亡率均比CK-MB非增高组高,两组差异有统计学意义[RR=2.88,95%CI(1.94,4.28),P<0.000 01;RR=3.64,95%CI(1.07,12.42),P=0.04]。无论on-pump或o pump,CK-MB增高组术后长期死亡率均比CK-MB非增高组高,两组差异有统计学意义[RR=2.55,95%CI(1.91,3.40),P<0.000 01;RR=3.36,95%CI(1.46,7.72),P=0.004]。cTnI测定值增高组术后短期及长期死亡率比非增高组高[RR=6.45,95%CI(2.50,16.66),P=0.000 1;RR=4.18,95%CI(2.78,6.28),P<0.000 01]。结论现有证据表明,冠脉移植旁路术后肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)测定值增高与术后短期及长期死亡率增高相关。Objective To evaluate the influences of myocardial injury markers on the short-term and long-term mortality after coronary artery bypass grafting （CABG）, so as to provide valuable references for clinical prognosis assess- ment. Methods Literature was electronically searched in CBM, PubMed, OVID, EMbase and CNKI from the date of their establishment to August 2011, meanwhile the manual searches were also performed to systemize the papers. Ac- cording to the Cochrane Handbook for systematic reviews, the studies were screened by two reviewers independently, the quality of the included studies was evaluated, the data were extracted, and meta-analysis was conducted using RevMan5.0 software. Results A total of 10 observational studies including creatine kinase-myocardial band （CK-MB） and cardiac troponin I （cTnI）, and the patients involved were 10 793 totally. Results of meta-analysis showed that the increasing re- lease of CK-MB was associated with an increasing short-term mortality risk of both on-pump （RR=2.88, 95%CI 1.94 to 4.28, P〈0.000 01） and off-pump group （RR=3.64, 95%CI 1.07 to 12.42）, P=0.04）. Also the increasing release of CK-MB was as- sociated with an increasing long-term mortality risk of both on-pump （RR=2.55, 95%CI 1.91 to 3.40, P〈0.000 01） and off- pump group （RR=3.36, 95%CI1.46 to 7.72, P=0.004）. The increasing release of cTnI was also associated with an increasing risk of both short-term mortality （RR=6.45, 95%CI 2.50 to 16.66, P〈0.1） and long-term mortality （RR=4.18, 95%CI 2.78 to 6.28, P〈0.1）. Conclusion The evidence shows that the increasing release of both CK-MB and cTnI is associated with an increasing risk of the short-term and long-term mortality.

关 键 词：冠脉移植旁路术 心肌损伤标记物 肌酸激酶同工酶 肌钙蛋白I META分析 

分 类 号：R654.2[医药卫生—外科学]