保留与不保留二尖瓣结构的瓣膜置换效果观察之Meta分析

Meta analysis of the valve replacement with or without mitral valve structure

目的:探讨保留部分或全部二尖瓣结构的瓣膜置换治疗风湿性二尖瓣疾病的有效性和安全性。方法:采用电子检索和手工检索进行文献初检,中国期刊全文数据库(CNKI:1998/2008)、中国生物医学数据库(CBM)、维普期刊网,收集国内外关于保留部分或全部二尖瓣结构在瓣膜置换术中应用的随机对照研究文献,对结果进行统计荟萃分析(Meta分析)。其中,试验组行保留二尖瓣结构的瓣膜置换,对照组行不保留二尖瓣结构的瓣膜置换。疗效及差异评价指标以比值比(RR)、加权均数差(WMD)和95%可信区间(CI)表示。统计学分析采用Review Manager4.2软件。结果:共收集国内4个随机对照研究,Meta分析结果显示:两组病例术后死亡率差异无显著性意义[RR0.34,95%CI(0.27,0.61),P>0.05];两组病例手术前后左心室内径大小均下降,试验组较对照组下降更为明显[RR6.10,95%CI(3.37,8.83),P<0.0001];试验组病例手术前后射血分数、心指数、每搏输出量改善均优于对照组。纳入文献均未报道相关严重不良反应。结论:保留部分或全部二尖瓣结构的瓣膜置换能更好地改善左心室内径大小、射血分数、心指数、每搏输出量,从而改善心脏功能,但要积极观察以避免出现二尖瓣再狭窄。

OBJECTIVE： To investigate the efficacy and safety of valve replacement with partly or whole mitral valve structure for treatment of rheumatic mitral valve disease. METHODS： Primary screening of the literatures was performed by net and by hand. Randomized control studies regarding the valve replacement with partly or whole mitral valve structure were screened out from Chinese Journal Full-text Database （CNKI： 1998/2008）, China BioMedical Literature Database and Weipu Journal Database. The results were involved in Meta analysis. Experimental group underwent valve replacement with mitral valve structure and control group underwent valve replacement without mitral valve structure. The therapeutic effect and difference were evaluated using the odds ratio, weighted mean difference and 95% confidence interval. Statistical analysis was done using Review Manager4.2 software. RESULTS： Four randomized control studies performed in China were involved. Meta analysis result have showed that there was no significant difference in the postoperative death rate between two groups [RR 0.34, 95% CI （0.27, 0.61 ）, P 〉 0.05]; The left ventricular internal diameter was both reduced in two groups after operation, especially in the experimental group [RR 6.10, 95%C/ （3.37, 8.83）, P 〈 0.000 1]. The experimental group was superior to control group with regard to the ejection fraction, cardiac index and stroke volume before and after operation. Severe adverse effect was absent in related reports. CONCLUSION： The valve replacement with partly or whole mitral valve structure can improve the ventricular internal diameter, ejection fraction, cardiac index and stroke volume, thus improving cardiac function. However, bicuspid valve restenosis should be avoided through active observation.