术前B型利钠肽水平预测冠状动脉旁路移植术后早期并发症:荟萃分析

A Meta-analysis of the Utility of Pre-operative Brain Natriuretic Peptide in Predicting Early Postoperative Complications in Patients with Coronary Artery Bypass Grafting

目的应用meta分析的方法评价术前B型利钠肽(BNP)水平在预测冠状动脉旁路移植术(CABG)术后早期并发症中的价值。方法计算机检索PubMed,Embase,Cochrane图书馆,中国期刊全文数据库及维普数据库,按照诊断试验的评价标准检索并筛选有关CABG术前BNP测定与术后早期并发症发生相关性的文献。根据QUADAS质量评价标准评价纳入文献的质量。采用Rev Man 5.2进行异质性检验及Meta-Disc1.4进行meta分析,对纳入文献进行加权定量合并,计算汇总灵敏度、特异度、诊断比值比、阳性似然比和阴性似然比及其95%可信区间(95%CI),绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积(AUC)。结果检出相关文献259篇,根据纳入标准最终入选5篇文献;共入选病例548例,其中术后发生早期并发症者160例,未发生者388例;术前增加的BNP浓度与术后早期并发症发生的诊断比值比(DOR)为14.92[95%CI(9.13,24.37)];汇总灵敏度为0.86[95%CI(0.79,0.91)],汇总特异度为0.74[95%CI(0.69,0.78)],汇总阳性似然比为3.65[95%CI(2.23,5.97)],汇总阴性似然比为0.20[95%CI(0.14,0.29)];SROC曲线的AUC为0.9018(Q值为0.8331)。结论术前BNP水平升高与术后早期并发症具有明显的相关性,是术后早期并发症发生的强预测因子,可以高度预测术后早期并发症的发生。

Objective We conducted a meta-analysis of the utility ofpre-operative B-type natriuretic peptide （BNP） in predicting early postoperative complications in patients with coronary artery bypass grafting （CABG）. Methods we searched PubMed, Embase, the Cochrane Controlled Trials Register databases, CNKI and VIP datebases, and we determined study eligibility and conducted data abstraction independently and in duplicate. We included the studies that the observational or randomized control trials measuring BNP concentrations in patients with CABG. The heterogeneity, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, the area under the SROC （AUC） were analyzed by the software of Rev Man 5.2 and Meta-Disc1.4. Results Of 259 studies identified, 5 studies met eligibility criteria, and included a total of 548 patients, among whom 160 experienced early postoperative complications after CABG. Elevated pre-operative BNP were significantly associated with early postoperative complications after CABG （DOR： 14.92, P〈0.01）. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and the AUC were 0.86 [95%Cl（0.79, 0.91）], 0.74 [95%Cl（0.69, 0.78）], 3.65 [95%Cl（2.23, 5.97）], 0.20 [95%Cl（0.14, 0.29）] and 0.9018, respectively. Conclusions These results suggest that an elevated pre-operative BNP measurement is a powerful, independent predictor of early postoperative complications after CABG.