冠状动脉旁路移植术治疗冠心病合并糖尿病患者有效性和安全性的Meta分析

Effectiveness and Safety of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Coronary Heart Disease Combined with Diabetic Mellitus:A Meta-Analysis

目的采用Meta分析方法评价冠状动脉旁路移植术(CABG)与经皮冠状动脉支架置入术(DES-PCI)比较治疗冠脉多支病变合并糖尿病患者的有效性和安全性。方法计算机检索e Cochrane Library、PubMed、MEDLINE、EMbase、CBM、CNKI、WanFang Data和VIP等数据库,并手工检索已发表的资料和会议论文,追索纳入文献的参考文献,收集有关冠脉多支病变合并糖尿病患者血运重建策略的随机对照试验,检索时限均从建库至2010年。由2位评价者根据纳入排除标准独立选择文献、提取资料和评价纳入研究的方法学质量,然后采用RevMan 5.0软件进行Meta分析。结果共纳入8个RCT,合计3 689例患者,其中CABG组1 814例,DES-PCI组1 875例。Meta分析结果显示:与DES-PCI组相比,CABG组能显著降低术后再次血运重建率[OR=0.27,95%CI(0.10,0.69),P=0.006]及主要心脑血管事件发生率[OR=0.49,95%CI(0.38,0.62),P<0.000 01],但在降低病死率[OR=0.84,95%CI(0.64,1.10),P=0.21]、脑血管事件发生率[OR=2.00,95%CI(0.97,4.14),P=0.06]及心肌梗死发生率[OR=0.92,95%CI(0.53,1.59),P=0.75]方面,两组差异均无统计学意义。结论 CABG治疗冠脉多支病变合并糖尿病患者的疗效明显优于DES-PCI。受纳入研究质量和数量所限,上述结论仍需更多大样本、多中心、前瞻性的随机对照研究加以验证。

Objective To evaluate the effectiveness and security through meta-analysis of a comprehensive study of efficacy of coronary artery bypass grafting （CABG） versus drug-eluting stent percutaneous coronary intervention （DES- PCI）, for diabetes mellitus with multi-vessel coronary disease. Methods Databases including The Cochrane Library, PubMed, MEDLINE, EMbase, CBM, CNKI, WanFang Data and VIP were searched from their establishment dates to 2010. Published information and conference papers including references were handsearched. Relevant randomized con- trolled trials （RCTs） on diabetic patients with coronary multi-vessel disease treated with revascularization were collected and screened by two reviewers independently. After data extraction and quality assessment of the included studies, meta- analysis was performed using RevMan 5.0. Results A total of eight studies involving a total of 3 689 cases （CABG group： 1 814 cases; DES-PCI group： 1 875 cases） were included. Results of meta-analyses showed that： compared with the DES- PCI group, the CABG group could significantly reduce postoperative repeat revascularization rate （OR=0.27, 95% CI 0.10 to 0.69, P=0.006） and major cardio-cerebral vascular events （OR=0.49, 95% CI 0.38 to 0.62, P〈0.000 01）. But in reducing mortality rate （OR=0.84, 95%CI 0.64 to 1.10, P=0.21）, cerebrovascular events （OR=2.00, 95%CI 0.97 to 4.14, P=0.06） and myocardial infarction incidence rate （OR=0.92, 95%CI 0.53 to 1.59, P=0.75）, there were no significant differences between the two groups. Conclusion CABG is superior to DES-PCI in the treatment of diabetic patients with multi-vessel dis- ease. However, due to the limitation of the quality and quantity of the included studies, the above conclusion should be tested by conducting more large-scale, multi-center and prospective RCTs in future.