继发性三尖瓣反流危险因素的Meta分析  

Risk Factors of Secondary Tricuspid Regurgitation:A Meta-Analysis

作　　者：虞聪[1] 董念国[1] 史嘉玮[1] 尹平[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,武汉430022 [2]华中科技大学同济医学院公共卫生学院流行病与卫生统计学系,武汉430030

出　　处：《中国循证医学杂志》2013年第12期1482-1491,共10页Chinese Journal of Evidence-based Medicine

基　　金："十二五"国家科技支撑项目:中国瓣膜病临床特点及外科治疗策略研究(编号:2011BAI11B19);国家自然科学基金:"组织工程化"模型探讨剪切力诱导心脏瓣膜钙化的机制研究(编号:81170214)

摘　　要：目的 应用Meta分析方法探讨左心瓣膜术（左心瓣膜置换或成形术，未同期行三尖瓣手术）术后继发性三尖瓣反流（TR）的危险因素，为指导临床诊治提供依据。方法 计算机检索PubMed、MEDLINE、CBM、CNKI、VIP等，纳入1995～2012年间有关左心瓣膜术后继发性三尖瓣反流危险因素的文献。根据纳入与排除标准筛选文献，提取资料和评价质量后采用RevMan 5.0软件进行Meta分析。结果 共纳入6篇文献，合计病例组437例，对照组2 102例。Meta分析结果显示以下因素与左心瓣膜术后三尖瓣反流进行性加重相关：术前房颤［OR=3.90，95%CI（3.00，5.07）］、校正后术前房颤［OR=3.04，95%CI（2.21，4.16）］、年龄［MD=5.36，95%CI（3.49，7.23）］、大左房［OR=5.17，95%CI（3.12，8.57）］或左房内径［MD=4.85，95%CI（3.18，6.53）］、校正后大左房［OR=1.91，95%CI（1.49，2.44）］、左心功能减低［OR=2.97，95%CI（1.73，5.08）］、风湿性病变［OR=3.06，95%CI（1.66，4.68）］、术前中度及以上TR［OR=3.52，95%CI（1.26，9.89）］和二尖瓣置换术（MVR）［OR= 2.35，95%CI（1.68，3.30）］。而性别［OR=1.54，95%CI（0.94，2.52）］，术前肺动脉高压［OR=1.28，95%CI（0.77，2.12）］与左心瓣膜术后TR进行性加重不相关。结论 影响左心瓣膜术后TR的危险因素包括术前房颤、年龄、大左房或左房内径、左心功能减低、风湿性病变、术前中度及以上TR、二尖瓣置换术。了解这些危险因素对防治左心瓣膜术后TR的远期疗效有一定指导意义。Objective To analyze and explore the risk factors of secondary tricuspid regurgitation （TR） after left-sided valve surgery （left cardiac valve replacement or valvuloplasty） using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation （OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16）, age （MD=5.36, 95%CI 3.49 to 7.23）, huge left atrium （OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44） or left atrium diameter （MD=4.85, 95%CI 3.18 to 6.53）, degradation of left heart function （OR=2.97, 95%CI 1.73 to 5.08）, rheumatic pathological change （OR=3.06, 95%CI 1.66 to 4.68）, preoperative TR no less than 2＋ （OR=3.52, 95%CI 1.26 to 9.89）, and mitral valve replacement （MVR） （OR=2.35, 95%CI 1.68 to 3.30）. Sex （OR=1.54, 95%CI 0.94 to 2.52） and preoperative pulmonary arterial hypertension （OR=1.28, 95%CI 0.77 to 2.12） were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2＋, and MVR. Understanding these risk factors helps us to improve the long-time effectivene

关 键 词：心脏瓣膜手术 三尖瓣反流 危险因素 META分析 

分 类 号：R654.2[医药卫生—外科学]