休克指数预测ST段抬高型心肌梗死患者预后的Meta分析

The value of shock index in evaluating the prognosis of patients with acute ST-segment elevation myocardial infarction:a Meta analysis

目的:评估休克指数(shock index,SI)在急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者预后中的预测价值。方法:通过计算机检索Pubmed数据库、EMBASE数据库、Cochrane图书馆、中国生物医学文献数据库、CNKI数据库、万方中文科技期刊数据库(自建库起至2018年8月),搜集有关SI预测STEMI患者预后的相关文章,评估SI与STMEI患者预后的关系。结果:纳入9篇文献,包括STEMI患者22 607例,其中高SI患者6 258例(高SI组),正常SI患者16 349例(正常SI组)。Meta分析结果显示:正常SI组短期内发生主要心脏不良事件(major adverse cardiac events,MACE)(RR:0.48,95%CI:0.44～0.53,P<0.01)、死亡(RR:0.27,95%CI:0.23～0.31,P<0.01)、心源性休克(RR:0.20,95%CI:0.10～0.41,P<0.01)、致命性心律失常(RR:0.49,95%CI:0.42～0.57,P<0.01)的风险均显著低于高SI组;正常SI组30 d内出现死亡的风险显著低于高SI组(RR:0.40,95%CI:0.26～0.62,P<0.01);正常SI组1年内发生MACE事件(RR:0.35,95%CI:0.23～0.54,P<0.01)、死亡(RR:0.27,95%CI:0.11～0.66,P<0.01)、心力衰竭(RR:0.26,95%CI:0.14～0.49,P<0.01)、心源性休克(RR:0.15,95%CI:0.12～0.18,P<0.01)的风险均显著低于高SI组;两组患者30 d及1年内再发心肌梗死差异无统计学意义。结论:SI能够有效预测STEMI患者短期、30 d及长期预后,可为临床提供一种简便易算的观察STEMI患者预后的指标。

Objective:To investigate the value of shock index(SI)in evaluating the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Method:The related data were obtained from Pubmed,EMBASE,Cochrane library,China Biomedical Literature Database,CNKI,Wanfang Chinese Science and Technology Journal Database(from the establishment of the library until August 2018),and collected the articles about SI in evaluating the prognosis of patients with STEMI,then assessed the relationship between SI and prognosis in patients with STEMI.Result:Nine studies including 22 607 patients with STEMI were included,6 258 patients with high SI(high SI group)and 16 349 patients with normal SI(normal SI group).Meta-analysis showed that in the short-term,risks of major adverse cardiac events(MACEs)(RR:0.48,95%CI:0.44-0.53,P<0.01),death(RR:0.27,95%CI:0.23-0.31,P<0.01),cardiogenic shock(RR:0.20,95%CI:0.10-0.41,P<0.01)and fatal arrhythmia(RR:0.49,95%CI:0.42-0.57,P<0.01)in normal SI group were significant lower than those in high SI group.Within 30 days,the risk of death in normal SI group was significant lower than that in high SI group(RR:0.40,95%CI:0.26-0.62,P<0.01).Within 1 year,risks of MACEs(RR:0.35,95%CI:0.23-0.54,P<0.01),death(RR:0.27,95%CI:0.11-0.66,P<0.01),heart failure(RR:0.26,95%CI:0.14-0.49,P<0.01)and cardiogenic shock(RR:0.15,95%CI:0.12-0.18,P<0.01)in normal SI group were lower than those in the high SI group,and the difference was statistically significant.There was no significant difference in recurrent myocardial infarction within 30 days or 1 year in two groups.Conclusion:SI can effectively predict the short-term,30-day and long-term prognosis of patients with STEMI,and providing an easy-to-use indicator for evaluation of the prognosis of patients with STEMI.