肺动脉血管造影评价急性肺栓塞右心功能情况的meta分析

Evaluation of right ventricular function in patients with acute pulmonary embolism by computed tomographic pulmonary angiography(CTPA):A meta analysis

目的探讨肺动脉血管造影(CTPA)在评估急性肺栓塞(APE)患者右心功能变化的临床应用价值。方法检索Pubmed、Embase、Web of Science、Cochrane、万方、维普和中国知网等数据库中关于CTPA分析APE患者右心功能的临床对照研究,时限为2000年1月至2023年2月。文献筛选后,以纽卡斯尔-渥太华量表(NOS)评估文献质量,Review Manager 5.4软件进行meta分析。结果与无APE患者相比,APE患者右心室与左心室最大直径比(RVd/LVd)(SMD=1.25,95%CI:0.94~1.56,P<0.05)、右心室与左心室最大截面积比(SMD=0.80,95%CI:0.71~0.89,P<0.05)、右心室与左心室容积比(SMD=1.42,95%CI:0.44~2.40,P<0.05)和右心室与左心室之间的最大距离比(SMD=0.91,95%CI:0.57~1.25,P<0.05)均明显增大。中央型APE患者RVd/LVd明显高于周围型APE患者(SMD=1.73,95%CI:0.95~2.51,P<0.05)。结论CTPA对APE右心功能情况具有良好的评估价值。

Objective To investigate the clinical application value of computed tomographic pulmonary angiography(CTPA)in the assessment of the changes of right ventricular function in patients with acute pulmonary embolism(APE).Methods We systematically retrieved the clinical controlled studies that exploring the evaluation of right ven-tricular function in patients with APE by CTPA from January 2000 to February 2023,which were published in PubMed,Embase,Web of Science,Cochrane,WanFang,VIP,and CNKI.Literature screening and data extraction were performed in-dependently by two investigators.Included articles were assessed for bias using the Newcastle-Ottawa scale.This meta-analysis was conducted using Review Manager version 5.4 software.Results Meta analysis indicated that ratio of the maximum diameter of right ventricle to left ventricle(RVd/LVd)(SMD=1.25,95%CI:0.94-1.56,P<0.05),ratio of the maximum cross-sectional area of right ventricle to left ventricle(SMD=0.80,95%CI:0.71-0.89,P<0.05),ratio of the volume of right ventricle to left ventricle(SMD=1.42,95%CI:0.44-2.40,P<0.05),and ratio of the maximum distance between the right ventricle and left ventricle(SMD=0.91,95%CI:0.57-1.25,P<0.05)of the APE group were signifi-cantly higher than those of the non-APE group.There was significant difference of RVd/LVd in central APE group com-pared with peripheral APE group(SMD=1.73,95%CI:0.95-2.51,P<0.05).Conclusion CTPA may be helpful for the evaluating the right ventricular function in patients with APE.