不同分期慢性肾脏疾病对主动脉瓣狭窄患者经导管主动脉瓣置换术预后影响的系统评价与Meta分析

Influence of different stages of chronic kidney disease on prognosis of patients with aortic stenosis after transcatheter aortic valve replacement:A systematic review and meta-analysis

目的系统评价不同分期慢性肾脏疾病(chronic kidney disease,CKD)对经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)患者预后的影响。方法计算机检索PubMed、the Cochrane Library、EMbase、Web of Science、中国知网(CNKI)、万方和中国生物医学文献数据库(CBM),搜集不同分期CKD对TAVR患者预后影响的队列研究,检索时限均从建库至2020年7月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 15.0软件进行Meta分析。研究偏倚风险评价采用纽卡斯尔–渥太华量表(Newcastle-Ottawa Scale,NOS)。结果共纳入17个队列研究。NOS评分均≥6分。Meta分析结果显示:与无CKD患者相比,CKD 3期患者30 d[RR=1.29,95%CI(1.22,1.37),P<0.001]及1年全因死亡率[RR=1.24,95%CI(1.19,1.28),P<0.001],CKD 4期患者30 d[RR=2.10,95%CI(1.91,2.31),P<0.001]及1年全因死亡率[RR=1.89,95%CI(1.62,2.19),P<0.001],CKD 5期患者30 d[RR=2.25,95%CI(2.00,2.52),P<0.001]及1年全因死亡率[RR=2.24,95%CI(1.75,2.87),P<0.001]显著升高且与CKD严重程度相关。在1年心血管死亡率、术后急性肾损伤、出血事件方面,CKD患者的发生率均较高。结论CKD 3期、4期、5期与TAVR术后全因死亡率的升高有关,且患者CKD分期越高,术后30 d和1年的全因死亡率越高。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the impact of chronic kidney disease(CKD)at different stages on prognosis of transcatheter aortic valve replacement(TAVR).Methods Databases including PubMed,the Cochrane Library,EMbase,Web of Science,CNKI,Wanfang and the Chinese Biomedical Literature Database(CBM)were searched by computer to collect cohort studies on impact of different stages of CKD on prognosis of TAVR from inception to July 2020.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies,and then,meta-analysis was performed by using Stata 15.0 software.Risk of study bias was assessed using the Newcastle-Ottawa Scale(NOS).Results A total of 17 cohort studies were included with NOS score≥6 points.The results of metaanalysis indicated that:compared with the patients without CKD,all-cause mortality of CKD stage 3 patients at 30 day(RR=1.29,95%CI 1.22-1.37,P<0.001)and 1 year(RR=1.24,95%CI 1.19-1.28,P<0.001),all-cause mortality of CKD stage 4 patients at 30 day(RR=2.10,95%CI 1.90-2.31,P<0.001)and 1 year(RR=1.89,95%CI 1.62-2.19,P<0.001),and all-cause mortality of CKD stage 5 patients at 30 day(RR=2.22,95%CI 1.62-2.19,P<0.001)and 1 year(RR=2.24,95%CI 1.75-2.87,P<0.001)were significantly increased and were associated with the severity of CKD.The occurrence rates of 1-year cardiovascular mortality,postoperative acute kidney injury and bleeding events were all higher in patients with CKD.Conclusion CKD at stages 3,4 and 5 is associated with increased all-cause mortality after TAVR,and the higher the stage of CKD is,the higher the risk of all-cause mortality at 30-day and 1-year follow-up is.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify above conclusions.