微循环障碍对急性冠脉综合征病人行经皮冠状动脉介入治疗预后影响的Meta分析  

Influences of Microvascular Dysfunction on Prognosis in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention:a Meta-analysis

作　　者：郎文 姜钧文[2] 季康寿 洪林巍[2] 李晨晨 LANG Wen;JIANG Junwen;JI Kangshou;HONG Linwei;LI Chenchen(Liaoning University of Traditional Chinese Medicine,Shenyang 110033,Liaoning,China)

机构地区：[1]辽宁中医药大学研究生学院,沈阳110033 [2]辽宁中医药大学附属医院,沈阳110032

出　　处：《中西医结合心脑血管病杂志》2020年第14期2217-2222,共6页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：辽宁省教育厅科学技术研究项目(No.L201628)。

摘　　要：目的探讨微循环障碍对急性冠脉综合征(ACS)病人行经皮冠状动脉介入治疗(PCI)预后的影响。方法计算机检索PubMed、EMbase、Cochrane Library,检索时间为建库至2018年7月26日。并对纳入文献及近年来相关综述的参考文献进行检索。收集关于微循环障碍对ACS行PCI预后的前瞻性队列研究,对符合纳入标准的研究进行质量评价和资料提取,应用相对危险度(RR)及其95%置信区间(CI)评价微循环障碍与死亡率以及复合事件[非致死性心肌梗死、心力衰竭、恶性心律失常或植入型心脏复律除颤器(ICD)植入、再灌注治疗]之间的相关性,采用I2和χ^2检验评估研究间的异质性。结果共纳入5项研究,587例病人。4项研究提供了病人6个月的死亡人数,3项研究提供了病人1年的死亡人数,3项研究报告了病人6个月内复合事件的发生例数,各研究之间均无明显异质性(χ^2=1.34,P=0.72,I2=0%;χ^2=1.22,P=0.54,I2=0%;χ^2=1.49,P=0.47,I2=0%)。Meta分析结果显示:微循环障碍组病人6个月、1年的死亡率均高于正常对照组[OR=6.05,95%CI(1.40,26.05),P=0.02;RR=7.63,95%CI(1.94,29.97),P=0.004];微循环障碍组病人6个月内复合事件发生率高于正常对照组[RR=3.60,95%CI(2.12,6.12),P<0.00001]。结论微循环障碍对于判断ACS病人行PCI的预后情况具有很高的价值,微循环障碍病人的远期死亡率和不良事件发生率显著高于微循环正常的病人。利用心脏超声造影对冠状动脉微循环进行评价,有助于临床医生对高危病人进行识别,并提前进行干预。Objective To investigate the effect of microvascular dysfunction on the prognosis of patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods PubMed,EMbase,and Cochrane Library were searched by computer.The retrieval time was from the establishment of the database to July 26,2018.The literature was screened,and evaluated,data were extracted.Risk ratios(RR)and 95%confidence interval(CI)were used to evaluate the association between death rate,cardiac events[nonfatal myocardial infarction,heart failure,malignant arrhythmia,implantable cardio-verter defibrillator(ICD)implantation,reperfusion therapy]and microvascular dysfunction.the chisqure test and the I2 test were used to assess heterogeneity.Results A total of 5 studies were included,including a total of 587 patients.Four studies provided 6-month death toll,3 studies provided 1-year death toll,and 3 studies reported cardiac events,there were low heterogeneity between those studies(χ^2=1.34,P=0.72,I2=0%;χ^2=1.22,P=0.54,I2=0%;χ^2=1.49,P=0.47,I2=0%).The 6-month and 1-year mortalities of patients with microvascular dysfunction were higher than those of the control group[OR=6.05,95%CI(1.40,26.05),P=0.02;RR=7.63,95%CI(1.94,29.97),P=0.004];the incidence of cardiac events in the microvascular dysfunction group was higher than that in control group[RR=3.60,95%CI(2.12,6.12),P<0.00001].Conclusion Microvascular dysfunction has great value in judging the prognosis of patients with ACS after PCI.The long-term mortality and adverse events rates of patients with microvascular dysfunction are higher than those with normal microcirculation.

关 键 词：急性冠脉综合征 微循环障碍 心脏超声造影 预后 META分析 

分 类 号：R743[医药卫生—神经病学与精神病学] R255.2[医药卫生—临床医学]