胸、腹主动脉覆膜支架主要不良反应事件发生率的Meta分析  

The incidence of the main adverse events of thoracic/abdominal aortic coated graft： a systematic review and meta-analysis

作　　者：李志霞[1] 王梦汝 李舜[1] 高盼君 孙凤[1] 詹思延[1] 

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,100191 [2]中国海洋大学海洋生命学院生物科学系,青岛

出　　处：《中华胸心血管外科杂志》2015年第8期466-471,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 系统评价胸、腹主动脉覆膜支架用于人体后所导致的心肌梗死、截瘫、肾衰竭、呼吸衰竭、脑卒中、全死因死亡6种主要不良反应事件的发生情况.方法 以“Thoracic aortic aneurysm/aneurysm of thoracic aorta/chest aortic aneurysm”、“Abdominal aortic aneurysm/abdominal aneurysm”、“Thoracic aortic coated stents/ thoracic stent graft”、“Abdominal aorta coated stents/abdominal stent graft”、“Endovascular aortic repair”和“Safety”等为关键词在PubMed、Embase、OVID、ProQuest、Elsevier和The Cochrane Library 6个数据库（均从最早至2014年5月）中制定检索策略,系统检索胸、腹主动脉覆膜支架导致上述6种主要不良反应事件的随访研究,包括随机对照试验研究、病例系列研究和队列研究.采用Meta-Analyst软件选择随机效应Meta分析模型对6种不良反应事件发生率进行加权合并;针对全死因死亡事件按照年龄、男性比例和随访时间进行亚组分析,并根据质量评价结果进行敏感性分析.结果 根据入选及排除标准,共纳入152篇文献,按随访时间拆分后形成264个研究.结果显示,胸主动脉覆膜支架总的不良反应事件发生率为12.2％,其中全死因死亡发生率最高（8.1％）,呼吸衰竭的发生率次之（6.5％）.腹主动脉覆膜支架总的不良反应发生率为4.6％,其中全死因死亡的发生率最高（4.0％）,心肌梗死的发生率次之（2.1％）.胸、腹主动脉覆膜支架亚组分析结果均提示,中年人群、男性比例较低的研究全死因死亡率较高;随访时间越长,全死因死亡率越高.结论 胸、腹主动脉覆膜支架用于人体后所导致的6种不良反应事件发生率均较高,尤其全死因死亡率最高,应对患者进行密切监测与随访.Objective The purpose of this study was to review all published reports on thoracic/ abdominal stent graft and investigate the incidence rates of six main adverse events（MAEs）：myocardial infarction,paraplegia,renal failure,respiratory failure,stroke and all-cause mortality.Methods Electronic databases（PubMed、Embase、OVID、ProQuest、Elsevier and The Cochrane Library） were searched from inception through May 2014 to identify studies that assessed the safety of thoracic/abdominal aortic coated stents on MAEs.The incidence rates with 95% confidence intervals（95% CIs） were derived using a random effects model,considering the heterogeneity between the included studies.Subgroup and sensitivity analyses were applied to explore heterogeneity.Results A total of 152 studies were included in the analysis with 264 arms.For thoracic stent graft,meta-analysis yielded a combined estimated incidence rates of 12.2%,and the most common MAEs was all-cause mortality （8.1%）,followed by respiratory failure （6.5 %）.For abdominal stent graft,meta-analysis yielded a combined estimated incidence rates of 4.6%,and the most common MAEs was all-cause mortality（4.0%）,followed by myocardial infarction（2.1%）.For thoracic and abdominal stent graft,subgroup analysis stratified by age and proportion of males indicated that middle-aged and females have a higher incidence rates of all-cause mortality.Besides,subgroup analysis stratified by follow-up time indicated that the longer follow-up time,the higher incidence rate of all-cause mortality.Conclusion The current evidence indicates that the incidence of MAEs of thoracic and abdominal stent graft is high,and we should pay more attention to the patients and follow up them as long as possible.

关 键 词：胸主动脉覆膜支架 腹主动脉覆膜支架 全死因死亡 发生率 META分析 

分 类 号：R725.631[医药卫生—儿科]