夜间低血压在非动脉炎性前部缺血性视神经病变中发生率的meta分析  

Occurrence of nocturnal hypotension in nonarteritic anterior ischemic optic neuropathy:a systematic review and meta-analysis

作　　者：王永平[1] 付俊霞 周欢粉[1] 宋宏鲁 杨沫[1] 魏世辉[1] Wang Yongping;Fu Junxia;Zhou Huanfen;Song Honglu;Yang Mo;Wei Shihui(Department of Ophthalmology,The Chinese People’s Liberation Army General Hospital&The Chinese People’s Liberation Army Medical School,Beijing 100853,China)

机构地区：[1]解放军总医院眼科医学部,北京100853

出　　处：《中华眼底病杂志》2021年第10期795-802,共8页Chinese Journal of Ocular Fundus Diseases

基　　金：政府间国际科技创新合作重点专项(2018YFE0113900)。

摘　　要：目的评价夜间低血压(NHP)在非动脉炎性前部缺血性视神经病变(NAION)中的发生率。方法循证医学研究。分别以NAION、夜间低血压为中英文检索词,在美国国立医学图书馆PubMed、荷兰医学文摘Embase、Web of Science、Cochrane图书馆、Clinical Trials、万方、中国知网、中国生物医学文献数据库检索相关文献。排除信息不完整或不相关文献以及综述性文献。采用Review Manager 5.4和STATA 15.0统计软件对文献进行meta分析。选择95%可信区间(CI)作为效应量的估计值。计算NAION中NHP发生率并进行敏感性分析和发表偏倚分析,以评估合并结果的稳定性。结果根据检索策略初步检索出159篇文献,最终纳入8篇文献进行meta分析,其中前瞻性、回顾性临床研究分别为3、5篇。NAION中NHP发生率为43%(95%CI 0.36~0.50)。敏感性分析证实证据可靠。亚组分析结果显示,白人、国人NAION患者NHP发生率近似,分别为47%(95%CI 0.39~0.55)、41%(95%CI 0.32~0.51);不同诊断标准NAION中NHP发生率,以夜间平均动脉压为诊断标准者高于以夜间收缩压和夜间舒张压为诊断标准者,分别为45%(95%CI 0.31~0.60)、40%(95%CI 0.32~0.50)。结论NAION中NHP发生率为43%;不同人种患者发生率接近。应以夜间平均动脉压<70 mm Hg(1 mm Hg=0.133 kPa)作为NHP诊断标准以提高诊出率。临床中应慎重干预存在NHP的NAION患者血压。Objective To evaluate the occurrence of nocturnal hypotension(NHP)in nonarteritic anterior ischemic optic neuropathy(NAION).Methods A evidence-based medicine study.Chinese and English as search terms for NAION and NHP was used to search literature in PubMed of National Library of Medicine,Embase,Web of science,Cochrane Library,Clinical Trials,Wanfang,and China National Knowledge Infrastructure and China Biology Medicine disc.Incomplete or irrelevant literature and review literature were excluded.The literature was meta-analyzed using Review Manager 5.4 and STATA 15.0.The 95%confidence interval(CI)were selected as the estimated value of effect size,the occurrence of NHP in NAION was calculated,and sensitivity analysis and publication bias analysis were also performed to assess the robustness of pooled outcomes.Results According to the search strategy,159 articles were initially retrieved,and 8 articles were finally included for meta-analysis,three prospective studies and five retrospective studies.The occurrence of NHP in NAION was 43%(95%CI,0.36-0.50).Sensitivity analyses confirmed that the evidence was robust.Subgroup analyses showed that the occurrence of NHP in NAION nearly the same in White patients(47%,95%CI 0.39-0.55)and Chinese patients(41%,95%CI 0.32-0.51).The occurrence of NHP in NAION was higher in using night mean artery pressure(45%,95%CI 0.31-0.60)as the diagnostic criteria than using night systolic blood pressure&night diastolic blood pressure(40%,95%CI 0.32-0.50).Conclusions The occurrence of NHP in NAION was 43%;the occurrence was similar in patients of different ethnicities.The diagnosis rate could be improved by using nMAP<70 mm Hg(1 mm Hg=0.133 kPa)as a diagnostic criterion for NHP.Careful intervention should be taken for the blood pressure of patients with NAION and NHP.

关 键 词：视神经病变 缺血性 低血压 META分析 

分 类 号：R774.6[医药卫生—眼科]