经导管封堵未闭卵圆孔对缺血性脑血管事件预防效果的Meta分析

Efficacy of transcatheter closure in preventing the recurrence of ischemic cerebrovascular events in patients with patent foramen ovale: a meta-analysis

目的系统评价经导管封堵未闭卵圆孔(PFO)对预防缺血性脑血管事件的效果。方法检索Pubmed、EMBASE、Cochrane图书馆、万方数字化期刊数据库以及中国知网数据库中对比封堵治疗与药物治疗预防缺血性脑卒中、短暂性脑缺血发作(TIA)等缺血性脑血管事件复发的相关研究,效应尺度指标选择比值比(OR)及其95%置信区间(CI),运用RevMan5.1软件行统计学分析。结果共纳入11篇文献。与对照组相比,PFO封堵治疗显著降低缺血性脑卒中[OR=0.47,95%CI(0.32,0.70),P=0.0002]和联合终点事件(缺血性脑卒中、全因死亡、短暂性脑缺血发作)的发生风险[OR=0.66,95%CI(0.46,0.95),P=0.02];两组患者之间TIA复发率[OR=0.67,95%CI(0.31,1.45),P=0.31]和全因死亡率[OR=0.81,95%CI(0.41,1.62),P=0.55]的差异无统计学意义。结论对于合并PFO的隐源性脑卒中患者,经导管封堵治疗比药物治疗更利于减少缺血性脑卒中的复发和联合终点事件的发生,其远期安全性和临床疗效有待更多大规模随机试验的评价。

Objective To evaluate the efficacy of transcatheter closure in preventing the recurrence of ischemic cerebrovascular events in patients with patent foramen ovale ( PFO).Methods Studies comparing the efficiency of transcatheter closure and medical therapy were searched from Pubmed ,EMBASE,Cochrane Library, CKNI and WanFang Digital Journal Database .The pooled effects were measured by weighted odds ratio ( OR ) and 95%confidence interval(CI).All statistical tests were performed with RevMan5.1 software.Results A total of 11 articles were included .Compared with control group ,transcatheter closure therapy may decrease the risk of recurrent ischemic stroke [ OR=0.47 ,95% CI ( 0.32 ,0.70 ) , P=0.0002 ] and composite end points [ OR=0.66 ,95% CI (0.46,0.95),P =0.02].There were no statistical difference in the comparison of recurrent transient ischemic attack [OR=0.67,95%CI(0.31,1.45),P=0.31]and all-cause death[OR=0.81,95% CI(0.41,1.62),P=0.55 ] .Conclusions In the cryptogenic stroke patients with PFO , transcatheter closure is superior to medical therapy for the prevention of recurrent ischemic stroke .Large scale randomized controlled clinical trials are required to determine its long-term efficacy and safety .