【摘要】：目的系統(tǒng)評價經皮二尖瓣夾合術(Mitra Clip)治療二尖瓣關閉不全合并心力衰竭患者的療效。方法計算機檢索維普、萬方數(shù)據(jù)庫、Pub Med、Cochrane圖書館、EMbase、CNKI、CBM,搜集二尖瓣關閉不全合并心力衰竭患者行Mitra Clip治療的對照試驗,檢索的時間限制為2005年10月至2017年2月。由2位評價員獨立篩選文獻、提取資料和評價納入研究的方法學質量后,采用Rev Man 5.2軟件進行Meta分析。結果最終納入10個研究,共計1091例患者,患者術前NYHA分級均大于Ⅰ級,其中88.5%為Ⅲ~Ⅳ級。Meta分析結果顯示,行Mitra Clip術后,患者左室射血分數(shù)(LVEF)顯著提高[MD= 2.97,95%CI( 5.06, 0.89),P=0.005],NYHA分級Ⅲ~Ⅳ級所占比例顯著下降[OR=72.87,95%CI(38.14,139.23),P0.00001],六分鐘步行試驗納入的研究結果間存在統(tǒng)計學異質性,(I 2=94%、P=0.01),考慮異質性產生原因與各納入的研究術前情況、隨訪時間有關,因納入研究較少,故未行亞組分析,但3個納入研究術后6分鐘步行距離平均值均較術前增加,二尖瓣反流程度明顯降低[OR=539.35,95%CI(307.29,946.64),P0.00001]。結論對二尖瓣關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并降低反流程度,但對于二尖瓣關閉不全合并心力衰竭患者在改善遠期生存率方面是否有優(yōu)勢尚待進一步研究證實。
[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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