限制性输血与开放性输血对急性心肌梗死患者预后影响的Meta分析

Meta-Analysis on Effect of Restrictive Blood Transfusion Versus Liberal Blood Transfusion Strategy in Patients with Acute Myocardial Infarction

目的采用Meta分析评价限制性输血与开放性输血策略对急性心肌梗死患者预后的影响。方法计算机检索PubMed、Embase、Web of Science、中国生物医学文献服务系统(SinoMed)、维普(VIP)、中国知网(CNKI)及万方数据知识服务平台(wanfang Data)中有关急性心肌梗死患者接受输血治疗的随机对照试验(RCT),检索时间均从建库至2022年12月。由2名研究者按照纳入排除标准筛选文献、提取资料,2名评价员独立对纳入文献的质量进行评价,采用RevMan5.3进行Meta分析,比较限制性输血与开放性输血策略对急性心肌梗死患者住院期间全因病亡率,总死亡率,随访再梗塞、非计划血管重建、心力衰竭及卒中发生等心血管不良事件的影响差异。结果最终纳入6项研究共3311例患者。Meta分析结果显示,限制性输血与开放性输血策略在院内死亡风险相对危险度(RR)RR=0.68,95%CI为0.31~1.48,P=0.33、总体死亡率(RR=0.83,95%CI为0.47~1.49,P=0.54)、随访再梗塞(RR=1.59,95%CI为0.38~6.75,P=0.53)、非计划血管重建(RR=0.83,95%CI为0.39~1.73,P=0.61)、心力衰竭(RR=0.74,95%CI为0.16~3.46,P=0.70)、卒中发生(RR=0.69,95%CI为0.14~3.48,P=0.65)等差异均无统计学意义。结论限制性输血与开放性输血比较,老年AMI患者住院期间全因病亡率,总死亡率,随访再梗塞、非计划血管重建、心力衰竭及卒中发生等心血管不良事件的发生率未见明显差异,由于纳入研究异质性较高,需更多RCT进一步证实,临床应谨慎对待本研究的结论。

Objective To evaluate the effect of restrictive blood transfusion versus liberal blood transfusion strategy in patients with Acute Myocardial Infarction using meta-analysis.Methods American Medical Library(PubMed),Holland Medical Abstract(Embase),Web of Science,SinMed,Weipu database,China National Knowledge Infrastructure(CNKI)and Wanfang databases were searched from their start year up to Dec.2022 for relevant randomized clinical trials(RCT)that compared restrictive blood transfusion to liberal blood transfusion in patients with Acute Myocardial Infarction.RCTs that met the inclusion criteria were screened and included,and meta-analysis was conducted using the RevMan5.3 software.The outcomes of in-hospital mortality,overall mortality,follow-up reinfarction,major adverse cardiovascular events(MACE)were evaluated.Results Six studies involving 3311 patients were included in this meta-analysis.The results of meta-analysis showed no significant difference between the two groups regarding the In-hospital mortality(RR(risk ratio)=0.68,95%CI:0.31~1.48,P=0.33),Overall mortality(RR=0.83,95%CI:0.47~1.49,P=0.54),Follow-up reinfarction(RR=1.59,95%CI:0.38~6.75,P=0.53),Unplanned revascularization(RR=0.83,95%CI:0.39~1.73,P=0.61),Heart Failure,(RR=0.74,95%CI:0.16~3.46,P=0.70)and Stroke(RR=0.69,95%CI:0.14~3.48,P=0.65).Conclusions No significant differences were seen in the In-hospital mortality,overall mortality,and the incidence of adverse cardiovascular events such as follow-up reinfarction,unplanned revascularization,heart failure and stroke occurrence in elderly patients with AMI when open transfusion was compared with restrictive transfusion.