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李波1，吳春蓉2，付世全1，陳青梅1，李元靜1 1. 重慶市江津區(qū)中心醫(yī)院 心內(nèi)科 (重慶 402260) ; 2. 重慶市江津區(qū)中心醫(yī)院 腫瘤科 (重慶 402260) 通信作者：吳春蓉, Email: lbwhu123@163.com 關(guān)鍵詞：冠狀動脈旁路移植術(shù)；經(jīng)皮冠狀動脈介入術(shù)；冠狀動脈粥樣硬化性心臟??；左室收縮功能不全 基金項(xiàng)目：重慶市江津區(qū)科技計(jì)劃項(xiàng)目（Y2017014） 引用本文：李波, 吳春蓉, 付世全, 陳青梅, 李元靜. 兩種血運(yùn)重建方式對冠狀動脈粥樣硬化性心臟病合并左室收縮功能不全患者預(yù)后影響的系統(tǒng)評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2019, 26(2): 158-164. doi: 10.7507/1007-4848.201712068 摘 要 目的 比較冠狀動脈旁路移植術(shù)（CABG）和經(jīng)皮冠狀動脈介入術(shù)（PCI）對冠狀動脈粥樣硬化性心臟?。ü谛牟。┖喜⒆笫沂湛s功能不全患者的臨床療效。 方法 計(jì)算機(jī)檢索 PubMed、The Cochrane Library 及 EMbase數(shù)據(jù)庫，檢索時間為建庫至 2017 年 10 月。同時瀏覽相關(guān)文獻(xiàn)的引文目錄，納入符合要求的臨床試驗(yàn)、隊(duì)列研究和病例對照研究。本研究的終點(diǎn)包括全因死亡率、心肌梗死、再次血運(yùn)重建和卒中，其效應(yīng)量均用相對危險度（RR）及其 95% 置信區(qū)間（CI）表示。 結(jié)果 最終納入 15 項(xiàng)隊(duì)列研究和 2 項(xiàng)隨機(jī)對照試驗(yàn)，共計(jì)患者 11 985 例，其中 CABG 組 6 322 例，PCI 組 5 663 例。Meta 分析結(jié)果表明，CABG 組患者的全因死亡率低于 PCI 組患者（18.6% vs.23.0%），差異具有統(tǒng)計(jì)學(xué)意義［RR=0.87，95% CI（0.81，0.94），P<0.001］。CABG 組再次血運(yùn)重建的風(fēng)險也顯著低于 PCI 組［RR=0.28，95% CI（0.19，0.42），P<0.001］，而兩組患者的心肌梗死［RR=0.78，95% CI（0.47，1.32），P=0.36］和卒中［RR=1.28，95% CI（0.89，1.86），P=0.18］的發(fā)生率無明顯差異。 結(jié)論 CABG 治療冠心病合并左室收縮功能不全患者的療效優(yōu)于 PCI。鑒于納入研究的質(zhì)量限制，該結(jié)論尚需更多大樣本的隨機(jī)對照試驗(yàn)來進(jìn)一步驗(yàn)證。 Abstract Objective To compare the clinical efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with coronary heart disease and left ventricular systolic dysfunction. Methods A computer-based search in PubMed, The Cochrane Library and EMbase up to October 2017, together with reference screening, was performed to identify eligible clinical trials, cohort studies and case-control studies. The outcomes of this meta-analysis included all-cause mortality, myocardial infarction, revascularization and stroke, and the effect sizes for them were presented as relative risk (RR) with its 95% confidence intervals (CI). Results Fifteen cohort studies and 2 randomized controlled trials were finally included with a total of 11 985 patients, of whom 6 322 were in the CABG group and 5 663 in the PCI group. The result of meta-analysis showed that all-cause mortality was significantly lower in the CABG group than that in the PCI group (18.6% vs. 23.0%, RR=0.87, 95% CI 0.81 to 0.94, P<0.001). In addition, CABG was associated with a remarkably reduced risk of revascularization (RR=0.28, 95% CI 0.19 to 0.42, P<0.001) compared with PCI, with no significant difference in incidence of myocardial infarction (RR=0.78, 95% CI 0.47 to 1.32, P=0.36) and stroke (RR=1.28, 95% CI 0.89 to 1.86, P=0.18). Conclusion CABG is superior to PCI in the treatment for patients with coronary heart disease and left ventricular systolic dysfunction. Owing to the limited quality of included studies, additional large, randomized controlled trails are still required to confirm this finding. 圖  圖1 文獻(xiàn)篩選流程圖  圖2 全因死亡率的 Meta 分析  圖3 心肌梗死、再次血運(yùn)重建和卒中的 Meta 分析 全文見：www.tcsurg.org/article/10.7507/1007-4848.201712068 |
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