生物瓣对比机械瓣治疗感染性心内膜炎的Meta分析

发布时间：2019-03-27 12:55

【摘要】：目的:系统评价生物瓣与机械瓣治疗感染性心内膜炎的预后,为临床治疗提供指导。方法:在PubMed、Cochrane、Embase、万方、知网数据库中收集生物瓣与机械瓣治疗感染性心内膜炎的临床研究,文献检索时间从1960年1月至2016年11月公开发表的论文,根据NOS量表评价纳入文献的质量并提取数据资料,采用Stata 12.0软件进行Meta分析。结果:最终纳入11篇文献,共入选病例10754例,其中生物瓣组6776例,机械瓣组3978例。研究分析结果显示,生物瓣组全因死亡率高于机械瓣组(合并HR=1.22,95%CI:1.03~1.44,p=0.023),差异有统计学意义;生物瓣组术后早期死亡率高于机械瓣组(合并RR=1.21,95%CI:1.02~1.43,p=0.033),差异有统计学意义;生物瓣组术后感染性心内膜炎复发率明显高于机械瓣组(合并HR=1.75,95%CI:1.26~2.42,p=0.001),差异有统计学意义;生物瓣组再次手术率高于机械瓣组(合并HR=1.79,95%CI:1.15~2.80,p=0.010),差异有统计学意义;生物瓣组术后栓塞发生率小于机械瓣组(合并RR=0.90,95%CI:0.76~1.07,p=0.245),差异无统计学意义。人工瓣膜感染性心内膜炎(PVE)患者置入生物瓣术后死亡率与机械瓣组相比无统计学差异(合并HR=0.91,95%CI:0.68~1.21,p=0.520)。结论:感染性心内膜炎患者外科手术治疗时,选择置入机械瓣可以提供比生物瓣更好的预后,包括更低的术后死亡率、复发率和再次手术率。导致这一结果的原因可能是纳入研究中两组患者基本情况的差异,而非瓣膜的功能障碍。
[Abstract]:Objective: to evaluate the prognosis of biological valve and mechanical valve in the treatment of infective endocarditis and to provide guidance for clinical treatment. Methods: clinical studies on the treatment of infective endocarditis with bivalve and mechanical valve were collected in PubMed,Cochrane,Embase, Wanfang, intellectual Web database. The literature was retrieved from January 1960 to November 2016. According to the NOS scale, the quality of the documents was evaluated and the data were extracted. The Meta analysis was carried out with Stata 12.0 software. Results: 10754 cases were enrolled in 11 literatures, including 6776 cases in bio-flap group and 3978 cases in mechanical valve group. The results showed that all-cause mortality in the biological valve group was higher than that in the mechanical valve group (with HR=1.22,95%CI:1.03~1.44,p=0.023), and the difference was statistically significant. The early postoperative mortality in the bio-valve group was higher than that in the mechanical valve group (with RR=1.21,95%CI:1.02~1.43,p=0.033), the difference was statistically significant. The recurrence rate of infective endocarditis in the bivalve group was significantly higher than that in the mechanical valve group (with HR=1.75,95%CI:1.26~2.42,p=0.001), the difference was statistically significant. The rate of re-operation in the biological valve group was higher than that in the mechanical valve group (with HR=1.79,95%CI:1.15~2.80,p=0.010), the difference was statistically significant. The incidence of embolization in the bio-valve group was lower than that in the mechanical valve group (with RR=0.90,95%CI:0.76~1.07,p=0.245), and there was no significant difference between the two groups. There was no significant difference in mortality between patients with prosthetic valvular infective endocarditis (PVE) and mechanical valve group (combined with HR=0.91,95%CI:0.68~1.21,p=0.520). Conclusion: when surgical treatment of infective endocarditis patients, mechanical valve placement can provide a better prognosis than biological valve, including lower postoperative mortality, recurrence rate and re-operation rate. This result may be due to the difference in basic conditions between the two groups of patients in the study, not valvular dysfunction.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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