左心房折叠术治疗左房室瓣病变合并巨大左心房临床疗效的Meta分析

Clinical Effect of Left Atrial Plication in Treating Mitral Valve Disease Merged with Giant Left Atrium: a Meta-Analysis

目的评价左心房折叠术(LAP)治疗左房室瓣病变合并巨大左心房(GLA)的临床疗效。方法计算机检索中国生物医学文献数据库(CBM)、维普网(VIP)、中国知网(CNKI)、万方数据知识服务平台、EMBase、PubMed、The Cochrane Library(2015年8期)等,筛选关于LAP治疗左房室瓣病变合并GLA临床疗效的病例对照研究和随机对照试验(RCT),检索时间为建库至2016年1月;对照组患者行左心瓣膜矫治手术,试验组患者在对照组基础上行LAP;采用RevMan 5.2软件进行Meta分析。结果共纳入6篇文献,其中英文文献3篇、中文文献2篇、日文文献1篇;包括251例患者,其中对照组114例,试验组137例。Meta分析结果显示,两组患者术后病死率比较,差异无统计学意义[OR=0.51,95%CI(0.19,1.37),P=0.18];两组患者低心排出量综合征发生率比较,差异无统计学意义[OR=0.42,95%CI(0.06,3.02),P=0.39];试验组患者左心房内径(LAD)[MD=12.99,95%CI(5.25,20.74),P=0.001]小于对照组,心胸比(C/T)[MD=4.50,95%CI(1.56,7.44),P=0.003]低于对照组,左心室射血分数(LVEF)[MD=-7.11,95%CI(-12.04,-2.18),P=0.005]高于对照组,美国纽约心脏病协会(NYHA)分级[MD=0.49,95%CI(0.47,0.51),P<0.000 01]优于对照组。结论现有证据表明,LAP可有效改善左房室瓣病变合并GLA患者心功能,且未增加患者病死率和低心排出量综合征发生率。

Objective To evaluate the clinical effect of left atrial plication in treating mitral valve disease merged with giant left atrium. Methods Computer was used to search CBM,VIP,CNKI,WANFANG Data,EMBase,PubMed, The Cochrane Library（ Issue 8,2015） to collect case-control studies and randomized controlled trials about clinical effect of left atrial plication in treating mitral valve disease merged with giant left atrium from creating database to January 2016; patients of control group received left heart valve orthopaedic operation,while patients of test group received left atrial placation based on left heart valve orthopaedic operation. The Meta-analysis was performed by RevMan 5. 2 software. Results A total of 6 literatures were enrolled in this Meta-analysis,including 3 English literatures,2 Chinese literatures and 1 Japanese literature,including114 cases in control group and 137 cases in test group. Meta-analysis results showed that,no statistically significant differences of postoperative fatality rate [OR = 0. 51,95% CI（ 0. 19,1. 37）,P = 0. 18 ]or incidence of low cardiac output syndrome[OR = 0. 42,95% CI（ 0. 06,3. 02）,P = 0. 39] was found between the two groups; LAD of test group was statistically significantly shorter than that of control group [MD = 12. 99,95% CI（ 5. 25,20. 74）,P = 0. 001 ],cardio-thoracic ratio（ C/T） of test group was statistically significantly lower than that of control group [MD = 4. 50,95% CI（ 1. 56,7. 44）,P =0. 003],LVEF of test group was statistically significantly higher than that of control group [MD =-7. 11,95% CI（-12. 04,-2. 18）,P = 0. 005],and NYHA grade of test group was statistically significantly better than that of control group [MD =0. 49,95% CI（ 0. 47,0. 51）,P 〈0. 000 01 ]. Conclusion According to the existing evidences,left atrial plication can effectively improve the cardiac function without increasing the risk of death or low cardiac output syndrome in treating mitral valve disease merged with giant left atrium.