早期手术治疗感染性心内膜炎疗效的Meta分析

Efficacy of Early Surgery for Infective Endocarditis: A Meta-analysis

目的系统评价早期手术治疗感染性心内膜炎的近期和远期疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data和CNKI数据库,搜集国内外有关早期手术治疗感染性心内膜炎疗效的队列研究,检索时限均为建库至2014年10月1日。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入16个队列研究,共计8 141例患者。Meta分析结果显示:早期手术可明显改善感染性心内膜炎患者的短期病死率[OR=0.57,95%CI(0.42,0.77),P=0.000 3]和长期病死率[OR=0.57,95%CI(0.43,0.77),P=0.000 2]。亚组分析结果显示,早期手术可明显降低自体瓣膜心内膜炎(NVE)患者的短期病死率和长期病死率。结论早期手术可明显降低感染性心内膜炎患者的短期病死率和长期病死率。受纳入研究数量和质量的限制,上述结论尚需开展大样本、高质量的研究进行验证。

Objective To systematically review the short term and long term efficacy of early surgery for infective endocarditis（IE） patients. Methods We searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases for cohort studies concerning the efficacy of early surgery for IE patients from inception to October 2014.Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software. Results Sixteen cohort studies including 8 141 patients were included. The results of meta-analysis showed that early surgery could reduce the short term mortality（OR=0.57, 95%CI0.42 to 0.77, P=0.000 4） and long term mortality（OR=0.57, 95%CI 0.43 to 0.77, P=0.000 7） in IE patients. Subgroup analysis showed that early surgery could significantly reduce the short term mortality and long term mortality in patients with native valve endocarditis（NVE）. Conclusion Early surgery can reduce IE patients＇ short term mortality and long term mortality. Due to the limited quality and quantity of the included studies, more large-scale high-quality studies are needed to verify the above conclusion.