经皮二尖瓣夹合术治疗二尖瓣关闭不全合并心力衰竭患者疗效的Meta分析

发布时间：2019-02-16 11:16

【摘要】：目的系统评价经皮二尖瓣夹合术(Mitra Clip)治疗二尖瓣关闭不全合并心力衰竭患者的疗效。方法计算机检索维普、万方数据库、Pub Med、Cochrane图书馆、EMbase、CNKI、CBM,搜集二尖瓣关闭不全合并心力衰竭患者行Mitra Clip治疗的对照试验,检索的时间限制为2005年10月至2017年2月。由2位评价员独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入10个研究,共计1091例患者,患者术前NYHA分级均大于Ⅰ级,其中88.5%为Ⅲ~Ⅳ级。Meta分析结果显示,行Mitra Clip术后,患者左室射血分数(LVEF)显著提高[MD= 2.97,95%CI( 5.06, 0.89),P=0.005],NYHA分级Ⅲ~Ⅳ级所占比例显著下降[OR=72.87,95%CI(38.14,139.23),P0.00001],六分钟步行试验纳入的研究结果间存在统计学异质性,(I 2=94%、P=0.01),考虑异质性产生原因与各纳入的研究术前情况、随访时间有关,因纳入研究较少,故未行亚组分析,但3个纳入研究术后6分钟步行距离平均值均较术前增加,二尖瓣反流程度明显降低[OR=539.35,95%CI(307.29,946.64),P0.00001]。结论对二尖瓣关闭不全合并心力衰竭的患者行Mitra Clip治疗,在一定程度上改善其心功能指标并降低反流程度,但对于二尖瓣关闭不全合并心力衰竭患者在改善远期生存率方面是否有优势尚待进一步研究证实。
[Abstract]:Objective to evaluate the efficacy of percutaneous mitral valve clamping (Mitra Clip) in patients with mitral insufficiency and heart failure. Methods A control trial of Mitra Clip therapy in patients with mitral insufficiency and heart failure was collected by computer retrieval of Weip, Wanfang database, Pub Med,Cochrane library and EMbase,CNKI,CBM,. The search time was limited from October 2005 to February 2017. After two evaluators independently sifted the literature, extracted the data and evaluated the methodological quality of the study, the Meta analysis was carried out with Rev Man 5.2 software. Results A total of 1091 patients were included in 10 studies. The preoperative NYHA grade was higher than that of grade 鈪，

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