RDW增加与急性心肌梗死患者长期预后关系的系统评价和meta分析

发布时间：2018-10-30 06:45

【摘要】：目的近年有许多研究显示RDW增加与急性心肌梗死患者长期不良预后密切相关,但各个研究结果不统一,本系统评价和meta旨在全面系统评价RDW增加对急性心肌梗死患者长期预后的预测价值,以便为临床提供协助判断急性心肌梗死患者长期预后的有效指标。方法全面系统的检索Pubmed、Embase、Cochrane library、Web of science等数据库发表的截止2015.7.21的潜在合格文章,应用渥太华纽卡斯尔量表(Newcastle-Ottawa Scale,NOS)对纳入的研究进行质量评估,提取有关急性心肌梗死患者RDW与患者预后情况(包括全因死亡、心血管原因死亡、再发心肌梗死住院、全因住院、心脏移植等)之间关系的数据,以风险比(HR)表示RDW增加与心肌梗死患者长期全因死亡率之间的关系,应用固定效应模型合并效应量HR,应用漏斗图来检验潜在发表偏移。结果本系统评价最终纳入11个合格的研究,包括14069名研究对象。合并效应量HR结果显示:RDW每增加1%长期全因死亡率的HR为1.12(95%可信区间为1.05-1.20),即RDW每增加1%急性心肌梗死患者长期全因死亡率增加12%;高RDW组患者与低RDW组相比长期全因死亡率的HR为2.43(95%可信区间,1.83-3.22),即高RDW组患者长期全因死亡率是低RDW组的2.43倍。但是在这些研究中存在发表偏倚。结论急性心肌梗死患者在入院、住院过程中或出院时红细胞分布宽度增加其长期不良预后风险增大,但还需要进一步大量研究来证实及阐明相关机制。
[Abstract]:Objective in recent years, many studies have shown that the increase of RDW is closely related to the long-term poor prognosis of patients with acute myocardial infarction, but the results of each study are not uniform. The purpose of this systematic evaluation and meta is to evaluate the value of RDW increase in predicting the long-term prognosis of patients with acute myocardial infarction (AMI), so as to provide an effective index for clinical evaluation of the long-term prognosis of patients with acute myocardial infarction (AMI). Methods A comprehensive and systematic search of potential eligible articles published by July 21, 2015 in Pubmed,Embase,Cochrane library,Web of science and other databases was carried out, and the quality of the included studies was evaluated with the Ottawa Newcastle scale (Newcastle-Ottawa Scale,NOS). To extract data on the relationship between RDW and prognosis of patients with acute myocardial infarction (including all death, cardiovascular death, hospitalization of recurrent myocardial infarction, total hospitalization, heart transplantation, etc.). The risk ratio (HR) was used to show the relationship between the increase of RDW and long-term all-cause mortality in patients with myocardial infarction. The fixed effect model combined with effect quantity HR, was used to test the potential publication deviation by funnel graph. Results the systematic evaluation included 11 qualified subjects, including 14069 subjects. The results of combined effect HR showed that the HR for every 1% increase in long-term total mortality of RDW was 1.12 (95% CI 1.05-1.20), that is, the long-term all-cause mortality of patients with acute myocardial infarction increased by 12% for each increase of 1% of RDW. The long-term total cause mortality of high RDW group was 2.43 (95% CI, 1.83-3.22) compared with that of low RDW group, that is, the long-term total cause mortality of high RDW group was 2.43 times of that of low RDW group. But publication bias exists in these studies. Conclusion the risk of long-term adverse prognosis of patients with acute myocardial infarction is increased by increasing the width of erythrocyte distribution during admission, during hospitalization or at discharge, but a large number of studies are needed to confirm and elucidate the related mechanism.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R542.22

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