覆膜支架腔内修复术对StanfordB型主动脉夹层治疗效果与安全性的Meta分析

Meta-analysis of the efficacy and safety of stent-graft endovascular repair for Stanford type B aortic dissection

目的使用Meta分析的方法系统评价覆膜支架腔内修复术对Stanford B型主动脉夹层(TBAD)的治疗效果与安全性。方法系统检索中国知网、万方数据库、维普、中国生物医学文献数据库、PubMed、Embase、the Cochrane Library和Web of Science等中英文数据库,收集覆膜支架腔内修复术治疗TBAD的随机对照试验(RCTs),检索时间为建库至2023年10月31日。对纳入文献进行质量评价并提取数据,应用Stata 16.0和RevMan 5.4软件对各项结局指标进行Meta分析。结果共纳入13篇RCTs进行Meta分析,包括1114例TBAD患者,其中575例接受覆膜支架腔内修复术。Meta分析结果显示,接受覆膜支架腔内修复术的试验组在生存率(OR=6.51,95%CI:3.50~12.11,P<0.01),再次手术或介入率(OR=0.33,95%CI:0.21~0.52,P<0.01),天门冬氨酸氨基转移酶(MD=-23.02 U/L,95%CI:-25.01~-21.03,P<0.01)、丙氨酸氨基转氨酶(MD=-14.28 U/L,95%CI:-15.58~-12.99,P<0.01)、血尿素氮(MD=-1.35 mmol/L,95%CI:-1.63~-1.06,P<0.01)和肌酐(MD=-23.43 mmol/L,95%CI:-26.30~-20.57,P<0.01)等肝肾功能指标上较对照组均显著改善。试验组TBAD患者内漏(OR=6.11,95%CI:0.73~51.34,P=0.10)和血管梗塞(OR=3.00,95%CI:0.31~29.16,P=0.34)的发生率与对照组差异无统计学意义;试验组脑梗塞(OR=0.14,95%CI:0.03~0.65,P=0.01)、肝肾功能障碍(OR=0.22,95%CI:0.07~0.74,P=0.01)和总并发症发生率(OR=0.30,95%CI:0.17~0.54,P<0.01)低于对照组,组间差异具有统计学意义。结论覆膜支架腔内修复术可有效改善TBAD患者的生存率,降低再次手术或介入率,在整体并发症上具有较好的安全性,在具体并发症方面尚需更多高质量文献进一步验证。

Objective To systematically evaluate the therapeutic effect and safety of stent-graft endovascular repair for Stanford type B aortic dissection(TBAD)using Meta-analysis.Methods Systematic retrieval of Chinese and English databases,including CNKI,Wanfang Database,VIP,CBM,PubMed,Embase,the Cochrane Library and Web of Science,to collect randomized controlled trials(RCTs)of endovascular stent-graft repair for TBAD,with the retrieval time from inception to October 31,2023.Quality assessment and data extraction were performed on the included literature,Stata 16.0 and RevMan 5.4 software were used to conduct meta-analysis on various outcome indicators.Results A meta-analysis of 13 RCTs was conducted,including 1114 patients with TBAD,of whom 575 underwent endovascular repair with covered stent.The meta-analysis results showed that the trial group that received endovascular repair with covered stent had significantly improved survival rate(OR=6.51,95%CI:3.50~12.11,P<0.01),reoperation or intervention rate(OR=0.33,95%CI:0.21~0.52,P<0.01),aspartate aminotransferase(MD=-23.02 U/L,95%CI:-25.01~-21.03,P<0.01),alanine aminotransferase(MD=-14.28 U/L,95%CI:-15.58~-12.99,P<0.01),blood urea nitrogen(MD=-1.35 mmol/L,95%CI:-1.63~-1.06,P<0.01)and creatinine(MD=-23.43 mmol/L,95%CI:-26.30~-20.57,P<0.01)compared with the control group.The incidence of endoleak(OR=6.11,95%CI:0.73~51.34,P=0.10)and vascular occlusion(OR=3.00,95%CI:0.31~29.16,P=0.34)in the TBAD patients of the experimental group had no statistically significant difference with the control group;the incidence of cerebral infarction(OR=0.14,95%CI:0.03~0.65,P=0.01),liver and kidney dysfunction(OR=0.22,95%CI:0.07~0.74,P=0.01)and total complications(OR=0.30,95%CI:0.17~0.54,P<0.01)in the experimental group were lower than the control group,and the difference between groups was statistically significant.Conclusion The stent-graft endovascular repair can effectively improve the survival rate of TBAD patients and reduce the rate of reoperation or intervention.It has better safety regarding overall complications,but more high-quality literature is needed to verify its effects on specific complications further.