心脏磁共振成像评估肺动脉高压患者右心室功能的Meta分析

The assessment of right ventricular function in patients with pulmonary arterial hypertension with cardiac magnetic resonance imaging： a Meta-analysis

目的探讨心脏磁共振成像（CMRI）对肺动脉高压（PAH）患者右心室功能的评估价值。方法计算机检索美国国立医学图书馆MEDLINE、万方数据库及中国知网数据库2001年1月至2015年4月发表的文献，检索词为：肺动脉高压、右心室功能、心脏核磁、pulmonary arterial hypertension、 right ventricularfunction、 cardiac magnetic resonance imaging。入选标准：研究设计为随机对照试验，试验对象为PAH患者，以同期健康志愿者作为对照；受试者均采用CMRI扫描，试验终点指标包括右室舒张期末容积（RVEDV）、右室收缩期末容积（RVESV）及右室射血分数（RVEF）。采用Cochrane协作网提供的RevMan5．0软件进行Meta分析；绘制漏斗图分析发表偏倚。结果最终检索到5篇文献满足入选条件，总计381例患者。连续性变量Meta分析结果显示，与健康对照组相比，PAH组RVEDV明显增加[加权均数差（WMD）=33．96，95％可信区间（95％CI）=20．80～47．12，P〈0．00001]，RVESV明显增加（WMD=41．91，95％CI=29．63～54．19，P〈0．00001），RVEF明显减小（WMD=-20．09，95％CI=-22．65--17．52，P〈0．00001）。结论采用CMRI可以相对无创而准确地评估PAH患者的右心室功能，CMRI在PAH患者右心室功能评估中具有重要意义。

Objective To explore the clinical value of cardiac magnetic resonance imaging （CMRI） in assessment of right ventricular function in patients with pulmonary arterial hypertension （PAH）. Methods The PubMed/MEDLTNE, Wanfang data, CNKI （from January 2001 to April 2015 ） were searched. The search terms were pulmonary arterial hypertension, right ventricular function, and cardiac magnetic resonance imaging. An inclusion criterion was the patients suffering from PAH, and the healthy volunteers were served as controls. The study was designed as randomized controlled trial. All the subjects investigated had received CMRI. The end of the trial included right ventricular end diastolic volume （RVEDV）, right ventricular end systolic volume （RVESV） and right ventricular ejection fraction （RVEF）. Meta analysis was conducted by RevMan 5.0 software provided by Cochrane Collaboration, and the publication bias was analyzed by the funnel plot analysis. Results Five papers involving 381 patients met the criteria. It was showed by Meta-analysis that compared with healthy control group, RVEDV was increase in PAH group [weighted mean difference （WMD） = 33.96, 95% confidence interval （95%CI） = 20.80-47.12, P 〈 0.000 01 ], RVESV was increased （WMD = 41.91, 95% CI = 29.63-54.19, P 〈 0.000 01 ）, and RVEF was decrease （WMD = -20.09, 95%CI = -22.65 to -17.52, P 〈 0.000 01 ）. Conclusion CMRI can be used to evaluate the right ventricular function of patients with PAH, and it has important significance in the evaluation of right ventricular function in patients with PAH.