肌钙蛋白对急性肺栓塞预后预测价值的Meta分析

发布时间：2018-08-08 21:33

【摘要】：目的采用Meta分析方法对目前已发表的关于肌钙蛋白预测急性肺栓塞(acutepulmonaryembolism,APE）患者预后的相关文献进行定量分析，通过评估急性肺栓塞患者中升高的肌钙蛋白水平与短期全因死亡事件，急性肺栓塞致死事件，，以及严重临床不良事件之间的联系，以明确肌钙蛋白在肺栓塞预后危险分层中的作用。方法搜索PubMed、WebofScience、OVID三个数据库中2003年1月至2012年5月1日之间的所有相关文献。这些文献的相关参考文献倘若可以提供关于肌钙蛋白水平以及短期全因死亡、急性肺栓塞致死、严重临床不良事件三种结局中至少一种结局的四格表也将被纳入研究。以事先制定的纳入剔除标准筛选文献后对资料进行质量评价和数据提取。利用Stata11.0和MetaDisc软件，依据文献异质性检验结果，进行随机效应模型或者固定效应模型meta分析。结果本篇meta分析纳入33篇文献共计7538名患者的资料。合并结果显示短期随访的急性肺栓塞患者中，较之肌钙蛋白水平正常组，肌钙蛋白水平升高组的全因死亡率、ＡPE致死率、临床不良事件率均明显升高（OR3.86，95%CI2.79to5.33；OR4.46，95%CI3.02to6.57；OR4.46，95%CI3.02to6.57）。这个结果在肌钙蛋白T亚组或者肌钙蛋白I亚组，以及前瞻性试验或回顾性试验中都保持一致。SROC曲线分析显示肌钙蛋白预测整体死亡事件的敏感性以及特异性之间的关系。结论肌钙蛋白水平升高与APE患者短期全因死亡率、PE致死率及临床不良事件发生率有显著相关性。通过测定患者肌钙蛋白水平可帮助提示APE患者预后分层，以便更好指导治疗。
[Abstract]:Objective to evaluate the relationship between elevated cardiac troponin levels and short-term all-cause death events in patients with acute pulmonary embolism (APE) by quantitative analysis of the published literatures on the prognosis of acute pulmonary embolism (ASE) by using Meta analysis, and to evaluate the relationship between cardiac troponin levels and short-term death events in patients with acute pulmonary embolism (APE), and to evaluate the relationship between cardiac troponin levels in patients with acute pulmonary embolism. The relationship between acute pulmonary embolism death events and severe clinical adverse events to clarify the role of troponin in prognostic risk stratification of pulmonary embolism. Methods all the relevant literatures from January 2003 to May 1, 2012 in three databases of PubMedus WebofScience OVID were searched. References to these papers will also be included in the study if they provide a four-box table on cardiac troponin levels, short-term all-cause deaths, acute pulmonary embolism deaths, and at least one outcome of severe clinical adverse events. The quality evaluation and data extraction were carried out on the basis of pre-established selection criteria. Using Stata11.0 and MetaDisc software, random effect model or fixed effect model meta analysis is carried out according to the results of literature heterogeneity test. Results this meta analysis included data of 7538 patients in 33 articles. The combined results showed that the mortality rate and clinical adverse events rate of patients with acute pulmonary embolism were significantly higher than those with normal cardiac troponin level (OR3.86-95CI2.79to 5.33 OR4.46-95CI3.02 to 6.57OR4.4995CI3.02CI3.02to 6.57OR4.495CI3.02to 6.57). The results were consistent in the troponin T subgroup or troponin I subgroup, and in prospective or retrospective tests. SROC curve analysis showed the relationship between sensitivity and specificity of troponin in predicting global death events. Conclusion there is a significant correlation between the elevation of troponin level and the mortality rate of PE and the incidence of clinical adverse events in patients with APE. The determination of troponin level in patients with APE may be helpful to predict the prognosis of patients with APE and to better guide the treatment.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.5

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