【摘要】：目的系統(tǒng)評(píng)價(jià)經(jīng)皮二尖瓣夾合術(shù)(Mitra Clip)治療二尖瓣關(guān)閉不全合并心力衰竭患者的療效。方法計(jì)算機(jī)檢索維普、萬(wàn)方數(shù)據(jù)庫(kù)、Pub Med、Cochrane圖書(shū)館、EMbase、CNKI、CBM,搜集二尖瓣關(guān)閉不全合并心力衰竭患者行Mitra Clip治療的對(duì)照試驗(yàn),檢索的時(shí)間限制為2005年10月至2017年2月。由2位評(píng)價(jià)員獨(dú)立篩選文獻(xiàn)、提取資料和評(píng)價(jià)納入研究的方法學(xué)質(zhì)量后,采用Rev Man 5.2軟件進(jìn)行Meta分析。結(jié)果最終納入10個(gè)研究,共計(jì)1091例患者,患者術(shù)前NYHA分級(jí)均大于Ⅰ級(jí),其中88.5%為Ⅲ~Ⅳ級(jí)。Meta分析結(jié)果顯示,行Mitra Clip術(shù)后,患者左室射血分?jǐn)?shù)(LVEF)顯著提高[MD= 2.97,95%CI( 5.06, 0.89),P=0.005],NYHA分級(jí)Ⅲ~Ⅳ級(jí)所占比例顯著下降[OR=72.87,95%CI(38.14,139.23),P0.00001],六分鐘步行試驗(yàn)納入的研究結(jié)果間存在統(tǒng)計(jì)學(xué)異質(zhì)性,(I 2=94%、P=0.01),考慮異質(zhì)性產(chǎn)生原因與各納入的研究術(shù)前情況、隨訪時(shí)間有關(guān),因納入研究較少,故未行亞組分析,但3個(gè)納入研究術(shù)后6分鐘步行距離平均值均較術(shù)前增加,二尖瓣反流程度明顯降低[OR=539.35,95%CI(307.29,946.64),P0.00001]。結(jié)論對(duì)二尖瓣關(guān)閉不全合并心力衰竭的患者行Mitra Clip治療,在一定程度上改善其心功能指標(biāo)并降低反流程度,但對(duì)于二尖瓣關(guān)閉不全合并心力衰竭患者在改善遠(yuǎn)期生存率方面是否有優(yōu)勢(shì)尚待進(jìn)一步研究證實(shí)。
[Abstract]:Objective to evaluate the efficacy of percutaneous mitral valve clamping (Mitra Clip) in patients with mitral insufficiency and heart failure. Methods A control trial of Mitra Clip therapy in patients with mitral insufficiency and heart failure was collected by computer retrieval of Weip, Wanfang database, Pub Med,Cochrane library and EMbase,CNKI,CBM,. The search time was limited from October 2005 to February 2017. After two evaluators independently sifted the literature, extracted the data and evaluated the methodological quality of the study, the Meta analysis was carried out with Rev Man 5.2 software. Results A total of 1091 patients were included in 10 studies. The preoperative NYHA grade was higher than that of grade 鈪，

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