威斯康星液和康斯特液与施尔生液心脏保存效果的系统评价  

Three preservation solutions for cold storage of heart allograft:a systematic review and meta analysis

作　　者：李勇男[1,2] 郭莎莎[1] 刘刚[1] 袁媛[1] 吉冰洋[1] 郑哲[3] 王巍[3] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院体外循环科,北京100037 [2]兰州大学第二医院心外科,兰州730000 [3]北京协和医学院中国医学科学院国家心血管病中心阜外医院心外科,北京100037

出　　处：《中国体外循环杂志》2015年第3期154-160,共7页Chinese Journal of Extracorporeal Circulation

基　　金：国家863计划"心脏移植标准化技术及免疫调控研究课题"

摘　　要：目的心脏移植中,心脏保存液有效地减轻供体心脏冷缺血保存期间的不利影响。但对威斯康星(UW)液、康斯特(HTK)液与施尔生(Celsior)液并无统一共识,本文就三种心脏保存液保存效果进行系统评价。方法系统检索PubMed、Embase、the Cochrane Library、the Centre for Evidence in Transplantationthe和International Clinical Trials Registry Platform文献数据库。采用患者术后生存率与供体心脏功能衰竭作为主要指标,采用院内死亡率作为次要指标。结果相比于Celsior液,UW液保存供体心脏后,患者术后30 d与90 d生存率较均较高(HR=1.16,95%CI=1.11-1.22,P<0.00001;RD=0.03,95%CI=0.01-0.05,P=0.002)。并且UW液保存供体心脏较少发生术后缺血性坏死(RD=-0.07,95%CI=-0.08--0.05,P<0.00001)。UW液保存后相比于HTK液也具有较高的术后生存率。供体心脏经HTK液与Celsior液保存后,术后移植物功能障碍发生率与院内死亡率均无统计学差异。结论心脏移植中,UW液在供体心脏冷缺血保存期间,保存效果优于Celsior液与HTK液,Celsior液和HTK液的保存效果并无明显差异。Objective Organ preservation solution has been designed to attenuate the detrimental effects during ischemic period.The aim of this study is to systematically evaluate the evidence comparing preservation solutions for heart preservation.Methods Studies were searched in PubMed,Embase,the Cochrane Library,the Transplant Library and the International Clinical Trials Registry Platform.The primary outcomes were patient survival and donor heart dysfunction.Secondary outcomes were in-hospital mortality and enzyme gene expression.Results UW was associated with a significantly improved survival at 30 days and 90 days（HR= 1.16,95%CI=1.11-1.22,P〈0.00001;RD = 0.03,95%CI = 0.01-0.05,P =0.002）,compared with Celsior.Heart allografts preserved with UW exhibited less ischemic necrosis than those preserved with Celsior（RD =-0.07,95%CI =-0.08—0.05,P〈 0.00001）.UW was associated with increased survival compared with HTK.No significant difference was observed in donor heart dysfunction and in-hospital mortality outcomes between HTK andCelsior solutions.Conclusion During cold static storage preservation,this study suggests that UW solution has superior clinical outcomes for heart transplantation compared with the other two organ preservation solutions.Besides,the protective effect of Celsior solution is similar to HTK solution on donor heart preservation.

关 键 词：心脏移植 器官保存 心脏保存液 系统评价 

分 类 号：R654.2[医药卫生—外科学]