球囊扩张式主动脉瓣膜置换术后急性肾损伤Meta分析

Meta-analysis of acute kidney injury in patients with aortic stenosis underwent balloon-expandable transcatheter aortic valve replacement

目的系统评价经导管球囊扩张式瓣膜置换术后急性肾损伤的发生率及预测因子。方法通过计算机检索中英文数据库中2009年1月至2015年10月发表的有关球囊扩张式主动脉瓣置换术后急性肾损伤研究的文献。利用疾病患病率或发病率质量准则评价文献质量,运用Comprehensive Meta Analysis 2.0软件进行Meta分析。结果最终纳入9个研究,其中,8个非随机对照研究,1个随机对照研究,共1 217例接受球囊扩张式主动脉瓣膜置换术的严重主动脉瓣狭窄患者。术后急性肾损伤的发生率为26.4%（95%可信区间23.6-29.4）。其中,3期急性肾损伤的发生率为6.2%（95%可信区间4.0-9.4）。球囊扩张式主动脉瓣膜置换术后,发生急性肾损伤的预测因子包括年龄、糖尿病、外周动脉疾病、基线肌酐水平、基线血红蛋白水平和造影剂使用量。结论球囊扩张式主动脉瓣置换术后,急性肾损伤的发生率较高,且可能导致严重的临床不良事件。深入研究其临床预测因子,有利于提高球囊扩张式主动脉瓣置换术后的安全性。

Objective To systematically evaluate the incidences and predictors of acute kidney injury （AKI） in patients with aortic stenosis underwent balloon-expandable transcatheter aortic valve replacement（TAVR）. Methods Through the computer retrieval da- tabase in both English and Chinese from January 2009 to October 2015 to search balloon-expandable TAVR after acute kidney injury research literature. The literature quality was assessed by Loney criteria. Meta-analyses were conducted by Comprehensive Meta-Analy- sis Version 2.0 software. Results Totally 9 eligible studies（8 nonrandom and 1 random clinical trial） included a total of 1,217 pa- tients in the meta-analysis. The incidence of all-stage acute kidney injury after TAVR was 26. 4% （95% CI 23.6-29.4）. The inci- dence of stage-3 acute kidney injury was 6. 2% （95 % CI 4.0-9.4 ）. The predictors of acute kidney injury after TAVR included age, di- abetes mellitus,peripheral arterial disease,baseline creatinine, baseline hemoglobin and contrast dosage. Conclusion The incidence of acute kidney injury after TAVR is high, which may be associated with major adverse events. Identification of acute kidney injury pre- dictors can improve the safety in patients with aortic stenosis underwent TAVR.