去骨瓣减压术治疗恶性大脑中动脉梗死的NNT评价  

Evaluation of early decompressive hemicraniectomy in malignant middle cerebral artery infarction by using NNT

作　　者：景宏菲[1] 管兴志[1] JING Hongfei, GUAN Xingzhi(Department of Neurology 2,Zhuozhou City Hospital ,Zhuozhou 072750,Chin)

机构地区：[1]涿州市医院神经内二科,河北涿州072750

出　　处：《中国实用神经疾病杂志》2018年第6期588-595,共8页Chinese Journal of Practical Nervous Diseases

摘　　要：目的运用NNT(Number Needed to Treat,每增加1例获益或受害的病人所需治疗的病人数)来评价早期去骨瓣减压术治疗恶性大脑中动脉梗死的疗效。方法合并DECIMAL、DESTINY和HAMLET三个随机对照试验的研究数据,然后运用算术法、随机重复获取数组法和专家认定法三种不同方法填充联合结局表(Joint outcome table),最后导出NNTB(Number Needed to Treat to Benefit,每增加1例获益的病人所需治疗的病人数)和NNTH(Number Needed to Treat to Harm,每增加1例受害的病人所需治疗的病人数)。结果两分法的分析显示:要获得mRS=0~2、mRS=0~3、mRS=0~4、mRS=0~5的净NNTBs分别是18.4、7.7、2.9和2.4。算术法的分析显示:每增加1例具有更好结局(即:使病人的mRS提高1个或数个等级的病人,对于5个等级的mRS(0~2,3,4,5,6),NNTB在1.7~2.4之间,对于4个等级的mRS(0~2,3,4,5~6),NNTB在2.0~2.9之间。专家认定法的分析显示:对于5个等级的mRS,生物学上最可信的NNTB是2.2(95%CI,2.0~2.3),而对于4个等级的mRS,其为2.6(95%CI,2.4~2.9),而且对于上述两种等级的mRS,NNTH均>100。随机重复获取数组法与专家认定法所得结果一致。结论根据对整个残障结局的整体分析,每100例经早期去骨瓣减压术治疗的病人,在术后1a时,有47个病人获得更好的结局,而只有不到1个病人的结局恶化。Objective We used number needed to treat to esti mate effects of early decompressive hemicraniectomy in ma- lignant middle cerebral artery infarction. Methods We pooled data from three recent RCTs and derived number needed to treat to benefit （NNTB） and harm （NNTH） values by populating joint outcome tables using algorithmic, repeated random sampling array,and expert specification techniques. Results In dichotomized analyses,net NNTBs were：to achieve mRS 0-2,18.4~mRS 0- 3,7.7;mRS 0-4,2.9, and mRS 0-5,2.4. Algorithmic analysis showed the NNTB for 1 additional patient to have a better outcome by one or more,mRS grades shouldlie between 1.7 and 2.4 for the 5 level mRS and between 2.0 and 2.9 for 4 level. Expert joint outcome table analysis indicated the biologically most plausible NNTB was 2.2 （95 G CI, 2.0-2.3） for the 5 level mRS, 2.6 （95 CI,2.4-2.9） for the 4 level,and the NNTH ~100 for both the 5 and 4 level mRS. Repeated simulation sampling was congruent with expert analysis. Conclusion Considering the full range of global disability outcomes, for every 100 patients treated with hemi- craniectomy,47 would have a better outcome and less than one have a worse outcome at one year if treated with early decompres- sive hemicraniectomy. When severe disability is valued as no better than death, there would still be more than one-third of hemi- craniectomy-treated patients achieve a better outcome.

关 键 词：去骨瓣减压术 恶性大脑中动脉梗死 残障 临床试验 荟萃分析 

分 类 号：R743.33[医药卫生—神经病学与精神病学]