经导管主动脉瓣置换与外科主动脉瓣置换治疗主动脉瓣狭窄疗效的Meta分析  

Efficacy of transcatheter aortic vavle repalcement and surgical aortic vavle replacement for aortic stenosis:a Meta analysis

作　　者：尹培永 崔小红[1] 熊婷 李素芳[3] 何喜民 Yin Peiyong;Cui Xiaohong;Xiong Ting;Li Sufang;He Ximin(Second Department of Internal Medicine,Sanya Traditional Chinese Medical Hospital,Sanya 572000,Hainan Province,China;Third Department of Internal Medicine,Sanya Traditional Chinese Medical Hospital,Sanya 572000,Hainan Province,China;Department of Cardiology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]三亚市中医院,内二科,海南省三亚市572000 [2]三亚市中医院,内三科,海南省三亚市572000 [3]北京大学人民医院心内科,北京市100044

出　　处：《中国组织工程研究》2019年第30期4905-4912,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81600340),项目负责人:李素芳~~

摘　　要：经导管主动脉瓣置换与外科主动脉瓣置换是治疗主动脉瓣狭窄的主要治疗方案,但研究者对2种方法的疗效、安全性和预后存在很大分歧。目的:应用循证医学手段探讨经导管主动脉瓣置换与外科主动脉瓣置换治疗主动脉瓣狭窄的疗效和预后。方法:在EMbase、Medline、PuMbed、维普等中、外数据库中查找经导管主动脉瓣置换与外科主动脉瓣置换治疗主动脉瓣狭窄的随机对照试验,利用Revman5.0对数据进行分析,比较两组短期(30d)和长期(1年)的死亡率、脑卒中发生率、心肌梗死发生率、出血发生率、肾损伤发生率和起搏器植入率。结果与结论:①共纳入8篇随机对照研究,包括6147例主动脉瓣狭窄患者,研究组(n=3136)进行经导管主动脉瓣置换组例,对照组(n=3011)进行外科主动脉瓣置换;②两组术后30d的死亡率、脑卒中发生率、心肌梗死发生率、出血发生率比较差异无显著性意义[OR=0.92,95%CI(0.74,1.13),Z=0.83,P>0.05;OR=0.82,95%CI(0.49,1.38),Z=0.74,P>0.05;OR=0.63,95%CI(0.38,1.05),Z=1.77,P>0.05;OR=0.50,95%CI(0.20,1.26),Z=1.47,P>0.05];研究组术后30d的肾损伤发生率低于对照组[OR=0.43,95%CI(0.33,0.57),Z=5.89,P<0.01],起搏器植入率高于对照组[OR=4.77,95%CI(1.36,16.72),Z=2.94,P<0.01];③两组术后1年的死亡率、脑卒中发生率、心肌梗死发生率比较差异无显著性意义[OR=0.93,95%CI(0.81,1.07),Z=1.02,P>0.05;OR=1.00,95%CI(0.81,1.23),Z=0.02,P>0.05;OR=0.88,95%CI(0.61,1.28),Z=0.65,P>0.05];研究组术后1年的起搏器植入率高于对照组[OR=3.47,95%CI(1.64,7.34),Z=3.26,P<0.01];④结果表明2种方法治疗主动脉瓣狭窄的疗效和预后相当,但经导管主动脉瓣置换治疗的手术创伤小、起搏器植入率较高。BACKGROUND: Transcatheter aortic vavle replacement and surgical aortic vavle replacement are the main treatment for aortic stenosis. However, the efficacy and prognosis between the two methods were still inconsistent. OBJECTIVE: To investigate the efficacy and prognosis of transcatheter aortic vavle repalcement and surgical aortic vavle replacement in the treatment of aortic stenosis with evidence-based medicine. METHODS: We searched relevant literature from Chinese and English databases such as EMbase, Medline, PubMed, and VIP to retrieve randomized controlled trial studies. Data were analyzed by Revman 5.0 to compare short-term (30 days) and long-term (1 year) mortality, incidence of stroke, incidence of myocardial infarction, incidence of hemorrhage, incidence of renal damage and rate of pacemaker implantation. RESULTS AND CONCLUSION: Eight randomized controlled trials involving 6 147 patients were included in the final analysis. Among these patients, 3 136 patients received transcatheter aortic valve replacement (study group) and 3 011 patients underwent surgical aortic valve replacement (control group). There were no significant differences in mortality, incidence of stroke, incidence of myocardial infarction, and incidence of hemorrhage between study and control groups at 30 days post-surgery [OR=0.92, 95%CI (0.74, 1.13), Z=0.83, P > 0.05;OR=0.82, 95%CI (0.49, 1.38), Z=0.74, P > 0.05;OR=0.63, 95%CI (0.38, 1.05), Z=1.77, P > 0.05;OR=0.50, 95%CI (0.20, 1.26), Z=1.47, P > 0.05]. At 30 days post-surgery, the incidence of renal damage in the study group was significantly lower than that in the control group [OR=0.43, 95%CI (0.33, 0.57), Z=5.89, P < 0.01], the rate of pacemaker implantation was significantly higher in the study group was significantly higher than that in the control group [OR=4.77, 95%CI (1.36, 16.72), Z=2.94, P < 0.01]. There were no significant differences in mortality, incidence of stroke, and incidence of myocardial infarction at 1 year post-surgery between study and control groups [OR=0.93,

关 键 词：瓣膜置换 主动脉瓣狭窄 经导管主动脉瓣置换 外科主动脉瓣置换 随机对照研究 导管 META分析 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]