远端缺血预处理对择期经皮冠状动脉介入治疗相关心肌损伤影响的Meta分析

The Effect of Remote Ischemic Preconditioning on Periprocedural Myocardial Infarction and Myocardial Injury in Patients Undergoing Elective Percutaneous Coronary Interventions: a Meta-analysis of Randomized Clinical Trials

目的:系统评价远端缺血预处理(RIPC)对冠心病患者行择期经皮冠状动脉(冠脉)介入治疗(PCI)发生介入性心肌损伤即4a型心肌梗死(4aMI)的预防及临床结局的影响。方法:计算机检索并收集从建库至2017年12月Cochrane library、PubMed、EMbase、Web of Science、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(CBM)中符合纳入标准的随机对照研究,并追溯纳入研究的参考文献和手工检索相关会议资料。由三位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Rvman 5.3软件进行Meta分析。结果:纳入7项随机对照研究,共1 198例患者,分RIPC组和对照组。Meta分析结果显示,RIPC组4aMI发生率低于对照组(RR=0.72,95%CI:0.63~0.83,P<0.001);RIPC组择期PCI术后心肌肌钙蛋白低于对照组(SMD=-1.64,95%CI:-1.92^-1.37,P<0.001);RIPC组患者随访的主要不良心脑血管事件发生率与对照组比较无显著差异(14.5%vs 14.8%,RR=0.97,95%CI:0.54~1.74,P=0.930)。结论:RIPC能够保护心肌,减轻PCI围手术期心肌损伤。

Objectives:This study systematically reviewed the available evidence to evaluate the incidence of myocardial infarction(MI)type 4a and the clinical outcome of remote ischemic preconditioning(RIPC)in patients undergoing elective percutaneous coronary intervention(PCI).Methods:Cochrane library,PubMed,EMbase,Web of Science,CNKI,Wanfang Data,VIP,CBM were systematically searched for randomized controlled trials of RIPC and control group in patients undergoing PCI,from inception to December 2017,related references and meeting documents were reviewed.RCT screening,data extraction and quality evaluation were performed independently by three investigators according to the inclusion exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 7 RCTs referring 1 198 patients were included.Meta-analysis showed that the incidence of 4aMI after elective PCI was lower in RIPC group than in the control group(RR=0.72,95%CI:0.63-0.83,P<0.001);cTn after elective PCI was lower in RIPC group compared with the control group(SMD:-1.64,95%CI:-1.92^-1.37,P<0.001);the incidence of MACCE did not differ between the two groups(RR=0.97,95%CI:0.54-1.74,P=0.930).Conclusions:This meta-analysis indicates that RIPC therapy before PCI can protect myocardium and reduce myocardial injury during the perioperative period in patients undergoing elective percutaneous coronary intervention.