MitraClip与外科手术治疗二尖瓣反流的安全性与有效性比较的Meta分析  

MitraClip system versus surgery in the treatment of mitral regurgitation:a Meta-analysis

作　　者：潘复泽[1] 韦恒[1] 周王威 郑鹏飞[1] 姚溪良 巫相宏[1] Pan Fuze Wei Heng Zhou Wangwei Zheng PenJei Yao Xiliang Wu Xianghong(Department of Cardiology, the First Affiliated Hospital of Guangxi Medical Universit)

机构地区：[1]广西医科大学第一附属医院心血管内科,南宁530021

出　　处：《重庆医科大学学报》2016年第12期1239-1244,共6页Journal of Chongqing Medical University

摘　　要：目的：评价MitraClip系统对比外科手术方式治疗二尖瓣反流（mitral regurgitation,MR）的安全性与有效性。方法：检索电子数据库Pub Med、Embase、Cochrane Library、中国期刊全文数据库网（CNKI）、中国科技期刊数据库（VIP）和万方等数据库,手工检索相关文献的引文列表,检索时限均从建库开始至2015年11月。纳入与MitraClip和外科治疗MR的比较相关的随机对照研究和前瞻性队列研究,逐个进行质量评价和资料提取,采用软件Stata11.2进行Meta分析。结果：共纳入5个研究,包括410位接受MitraClip系统治疗及353位接受外科手术治疗的MR患者。Meta分析结果示：MitraClip组1年生存率不劣于外科手术组（RR=0.985,95%CI=0.933~1.040,P=0.576）、不增加30 d死亡率（RR=0.513,95%CI=0.190~1.384,P=0.188）,在1年心功能达纽约心功能分级III/IV级的人数、急性肾损伤事件发生率、神经系统事件发生率和30 d主要不良事件发生率比较中,差异无统计学意义;在术后MR≤2＋级（RR=0.858,95%CI=0.796~0.926,P=0.000）和输血事件发生率（RR=0.303,95%CI=0.197~0.464,P=0.000）的比较中,MitraClip系统治疗组均低于外科手术治疗组。结论：尽管MitraClip组患者更高危,但是MitraClip治疗MR术后1年生存率和30 d死亡率不劣于外科手术并能减少手术并发症,但术后MR的缓解不如外科手术。Objective：To assess the efficacy and safety of MitraClip versus surgery in treatment of mitral regurgitation（MR）. Methods：The Pub Med,Embase,Cochrane Library,CNKI,VIP and Wan Fang were electronically searched from inception to November 2015 for all the randomized controlled trial and prospective cohort study with MitraClip and surgical treatment of mitral regurgitation. Related journals and the related references were also searched and tracked. Results：A total of five elected studies involving 763 patients were included. Meta-analysis showed that：there was no statistically significant difference in the one-year survival rates（RR=0.985,95%CI=0.933 to 1.040,P=0.576）and 30-day mortality（RR=0.513,95%CI=0.190 to 1.384,P=0.188）. There was no statistically significant difference in the one-year NYHA Class III/IV,acute kidney injury events,neurological events and30-day major adverse events. The post-procedure residual MR severity ≤2＋ events（RR=0.858,95%CI=0.796 to 0.926,P=0.000）and the blood transfusion events（RR=0.303,95%CI=0.197 to 0.464,P=0.000）was significantly lower in the MitraClip group than in surgical group. Conclusion：Despite a higher risk profile in the MitraClip patients compared to surgical intervention,efficacy and safety of MitraClip system is not worse than surgeryin the treatment of mitral regurgitation.

关 键 词：MITRACLIP 治疗 二尖瓣反流 META分析 

分 类 号：R749[医药卫生—神经病学与精神病学]