急性心肌梗死患者急诊PCI术中无复流影响因素的Meta分析

发布时间：2018-06-15 12:43

本文选题：急性心肌梗死 + 经皮冠状动脉介入　；参考：《延安大学》2017年硕士论文

【摘要】：目的:本研究采取Meta分析综合概括急性心肌梗死患者急诊PCI术中发生无复流的临床常见影响因素及其关联强度,主要包括:(1)中性粒细胞/淋巴细胞比值(NLR);(2)合并2型糖尿病;(3)合并低血压;(4)发病-再灌注时间延长;(5)无侧支循环形成;(6)血栓负荷重;(7)hsCRP升高;(8)多支架置入;(9)多支病变,综合分析上述危险因素与无复流发生的相关性,为无复流的预测及预防提供可靠的循证学依据。方法:严格按照Cochrane协作网对文献检索的要求,通过Pubmed、Springer、Cochrane、学引文检索(SCI)、Embase、Medline、CNKI、万方、维普等数据库进行检索无复流相关危险因素,尽可能全面收集本研究文献,检索时间范围为2002年1月至2017年1月,将中文及英文限定为筛选语种。采用系统综述分析所纳入的文献,效应量采用比值比(OR)表示,各效应量区间范围采用95%CI表示,各研究之间的异质性分析采用Q检验。最终纳入临床常见的9个无复流危险因素:(1)中性粒细胞/淋巴细胞比值(NLR);(2)合并2型糖尿病;(3)合并低血压;(4)发病-再灌注时间延长;(5)无侧支循环形成;(6)血栓负荷重;(7)hsCRP升高;(8)多支架置入;(9)多支病变,纳入有价值的原始数据,最终使用RevMan5.3统计软件进行Meta分析。结果:依据纳入标准,通过一系列筛选后最终纳入20篇与无复流危险因素相关的文献,中文8篇,英文12篇。Meta分析结果如下:1.NLR值:合并效应量OR值为1.27,95%CI(0.89,1.66),P0.05。2.合并2型糖尿病:合并效应量OR值为14.77,95%CI(11.50,18.98),P0.05。3.合并低血压:合并效应量OR值为10.00,95%CI(5.06,19.77),P0.05。4.发病-再灌注时间:合并效应量OR值为4.94,95%CI(4.70,5.18),P0.05。5.无侧支循环:合并效应量OR值为17.22,95%CI(13.87,21.39),P0.05。6.血栓负荷:合并效应量OR值为13.94,95%CI(10.24,18.99),P0.05。7.hsCRP:合并效应量OR值为10.57,95%CI(9.93,11.20),P0.05。8.多支架置入:合并效应量OR值为13.89,95%CI(10.27,18.77),P0.05。9.多支病变:合并效应量OR值为7.83,95%CI(6.28,9.75),P0.05。结论:目前临床上对于无复流的病因及发病机制尚无明确定论,本研究对无复流的临床常见危险因素进行Meta分析后认为,中性粒细胞/淋巴细胞比值(NLR)、合并2型糖尿病、合并低血压、发病-再灌注时间延长、无侧支循环形成、血栓负荷重、hs CRP升高、多支架置入及多支病变是无复流现象的危险因素,关联强度由强至弱为:无侧支循环、合并2型糖尿病、血栓负荷、多支架置入、hsCRP、合并低血压、多支病变、发病-再灌注时间、NLR。利用以上结论,在临床工作中可以预测及预防无复流的发生,为应对无复流的发生提供应对空间。
[Abstract]:Objective: in this study, Meta-analysis was used to summarize the common clinical factors and the associated strength of the patients with acute myocardial infarction (AMI) who had no reflow during emergency PCI. These include: 1) neutrophil / lymphocyte ratio (NLRX 2) with type 2 diabetes mellitus (3) complicated with hypotension (4) pathogenesis-reperfusion time prolongation (n = 5) No collateral circulatory formation (n = 6) thrombus load: 7? s CRP elevated? The correlation between the above risk factors and the occurrence of no reflow was comprehensively analyzed in order to provide a reliable evidence-based basis for the prediction and prevention of non-reflow. Methods: according to the requirements of Cochrane Cooperative Network for literature retrieval, the relevant risk factors of no reflow were retrieved by Pubmedmeda Springerus Cochraneand Citation search in CNKI, Wanfang, Wiper and other databases, so as to collect the relevant literature as comprehensively as possible. The retrieval time ranges from January 2002 to January 2017, and the Chinese and English languages are limited to the selected languages. The literature included in this paper is systematically reviewed and analyzed, the effect quantity is expressed by ratio, the range of each effect quantity is expressed by 95 CI, and the heterogeneity of each study is analyzed by Q test. The nine common clinical risk factors without reflow, 1: 1) neutrophil / lymphocyte ratio (NLRR1) 2) with type 2 diabetes mellitus (3) complicated with hypotension (4) pathogenesis-reperfusion time prolongation, (5) collateral circulation formation and thrombotic load (6) were included in the clinical trial of 9 common risk factors of no reflow (1: 1) neutrophil / lymphocyte ratio (2) type 2 diabetes mellitus (3) and hypotension. Multiple stents were placed in 9) multivessel lesions. Incorporating valuable raw data and eventually using RevMan5.3 statistical software for meta-analysis. Results: according to the inclusion criteria, 20 articles related to no risk factors of reflow were selected, 8 in Chinese and 12 in English. The results of Meta analysis were as follows: 1. NLR value: OR value of combined effect was 1. 2795 CIQ 0.89 / 1. 66% P 0. 05.2. Type 2 diabetes mellitus: the OR value of the combined effect volume was 14.77% 95% CI 11.50 ~ 18.98% P0.05.3. Combined hypotension: OR value of combined effect was 10.00 ~ 95CIQ 5.06 ~ 19.77% P0.05.4. The incidence and reperfusion time: the OR value of the combined effect was 4.94% 95% CI: 4.70% 5.18% P0.05.5%. No collateral circulation: the OR value of the combined effect was 17.22 / 95 CIQ 13.87 ~ 21.39% (P0.05.6). Thrombus load: the OR value of combined effect was 13.94% 95% CI 10.24 ~ 18.99 ~ 18.99% P 0.05.7.hs CRP0.The OR value of combined effect was 10.57 卤95% CI 9.93% 11.20% P 0.05.8. Multiple stent placement: the OR value of combined effect was 13.89 卤95CI 10.27 ~ 18.77% P 0.05.9. Multivessel lesion: the OR value of combined effect was 7.83% 95% CI 6.289.75% P0.05. Conclusion: at present, there is no definite conclusion on the etiology and pathogenesis of non-reflow in clinic. After meta-analysis of the common clinical risk factors of non-reflux, it is concluded that the neutrophil / lymphocyte ratio (NLRN) may be associated with type 2 diabetes mellitus (T2DM). Associated hypotension, prolonged duration of pathogenesis-reperfusion, formation of no collateral circulation, elevated hs CRP under heavy thrombus load, multi-stent implantation and multi-vessel lesion were risk factors of no-reflow phenomenon. The correlation strength from strong to weak was as follows: no collateral circulation. Patients with type 2 diabetes mellitus, thrombus load, multiple stents implanted with hsCRP, hypotension, multiple vessel lesions, pathogenesis-reperfusion time and NLR. Using the above conclusions, we can predict and prevent the occurrence of no reflow in clinical work, and provide a response space for the occurrence of no reflow.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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