心脏储备的人群调研数据荟萃分析研究

发布时间：2018-11-08 16:52

【摘要】： 心脏储备指的是心脏功能上调可能性的大小,即心脏潜力的大小。心脏储备的下降或丧失将导致不良预后,不能对付应激事件,例如运动或分娩,甚至稍强的日常活动。用荟萃分析(Meta分析)的方法对国内外资料和课题组调研获得的数据资料进行统计学分析,评价运动锻炼、女性怀孕对其心脏储备的影响,并分析舒张期/收缩期时限比值(D/S)指标在孕前女性和孕妇、以及不同孕期孕妇间的临界值。按Cochrane协作网工作手册的要求,制定相应的纳入、排除标准及检索策略;以PubMed为英文文献主要来源,以中国生物医学文献数据库为中文文献主要来源,搜索2007年以前在国内外公开发表的有关“心脏储备”的文献;作者和课题组另一成员对搜索到的文献进行质量评估,根据纳入标准和排除标准确定纳入荟萃分析的资料;按照循证医学的原理和思想与5个科研协作中心合作,利用作者设计的心脏储备人群调研数据分析管理系统进行心音信号数据的采集;以加权均数差值(WMD)作为合并效应量评价运动锻炼、女性怀孕对其心脏储备的影响;用受试者工作特征曲线(ROC曲线)评价D/S在孕前女性和孕妇、以及不同孕期孕妇间的临界值。根据预先确定的搜索策略对PubMed和CBM等数据库进行检索,共搜索到12篇基于心音检测心脏储备的文献,手工搜索到1篇论著,按照纳入标准和排除标准对文献进行筛选,符合条件的文献共4篇,均为随机对照研究。用RevMan4.2和SPSS11.5分析表明,运动员心脏储备较普通人群有显著性差异,说明心肌收缩能力储备指数(CCRI)指标用于评价普通人群和运动员的心脏储备是有效的,运动训练有利于心脏储备的增加;对纳入的5个科研协作中心的数据资料进行荟萃分析显示,孕妇心脏储备较孕前女性有明显差异,说明D/S指标用于评价孕前女性和孕妇的心脏储备是有效的,怀孕这一应激事件动用了心脏储备,使其备用部分减小;根据D/S的ROC曲线评价孕前女性和孕妇、早中孕期和晚孕期孕妇的D/S的临界值分别为1.445,1.275;敏感度分别为82.4%,65.7%。对普通人群和运动员、孕前女性和孕妇、不同孕期孕妇心脏储备做的荟萃分析结果表明,CCRI、D/S能够有效的评价心脏储备;孕前女性和孕妇、早中孕期和晚孕期孕妇的D/S的临界值能为采取保障孕妇心脏健康的措施提供参考依据。
[Abstract]:Cardiac reserve refers to the magnitude of the likelihood of an up-regulation of heart function, that is, the magnitude of cardiac potential. A decline or loss of cardiac reserves can lead to poor prognosis and inability to cope with stress events, such as exercise or childbirth, or even stronger daily activities. Meta-analysis (Meta analysis) was used to evaluate the effects of exercise and pregnancy on cardiac reserve. The critical values of the ratio of diastolic / systolic duration (D / S) between prepregnant women and pregnant women, as well as between pregnant women with different gestations were analyzed. According to the requirements of the Cochrane cooperation network work manual, to formulate the corresponding inclusion, exclusion standards and retrieval strategy; Using PubMed as the main source of English literature and Chinese biomedical literature database as the main source of Chinese literature, the literature on "cardiac reserve" published at home and abroad before 2007 was searched. The author and another member of the research group conduct a quality assessment of the literature searched and determine the information to be included in the meta-analysis according to the inclusion criteria and exclusion criteria; According to the principle and thought of evidence-based medicine, the author used the heart reserve research data analysis and management system designed by the author to collect the heart sound signal data in cooperation with five scientific research cooperation centers. The weighted mean difference (WMD) was used to evaluate the effect of exercise and pregnancy on the cardiac reserve. The critical values of D / S between prepregnant women and pregnant women, and between pregnant women with different gestations were evaluated by using the ROC curve. According to the pre-determined search strategy, the PubMed and CBM databases were searched, and 12 articles were searched based on cardiac sound detection, 1 paper was searched by hand, and the literature was screened according to the inclusion criteria and exclusion criteria. There were 4 articles in accordance with the conditions, all of which were randomized controlled studies. RevMan4.2 and SPSS11.5 analysis showed that there was significant difference in cardiac reserve between athletes and the general population, which indicated that the index of myocardial contractility reserve index (CCRI) was effective in evaluating the cardiac reserve of the general population and the athletes. Exercise training is beneficial to the increase of cardiac reserve. A meta-analysis of the data from the five research collaborating centers showed that the cardiac reserve of pregnant women was significantly different from that of pre-pregnant women, indicating that the D / S index was effective in evaluating the cardiac reserve of prepregnant women and pregnant women. The stress event of pregnancy uses the heart reserve to reduce the spare part; According to the ROC curve of D / S, the critical value of D / S was 1.4451.275 and the sensitivity was 82.4% and 65.7%, respectively. Meta-analysis of cardiac reserve in general population and athletes, pre-pregnant women and pregnant women with different pregnancies showed that CCRI,D/S could effectively evaluate cardiac reserve. The critical value of D / S in pre-pregnant women and pregnant women in early and late pregnancy can provide a reference for taking measures to protect the heart health of pregnant women.
【学位授予单位】：重庆大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R311

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