主动脉夹层患者院内死亡相关危险因素的荟萃分析
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摘要
目的通过荟萃分析寻找主动脉夹层(AD)患者院内死亡的相关危险因素。方法计算机检索Cochrane Library、Elsevier ScienceDirect、PubMed/Medline、万方数据知识服务平台、中国知网、维普期刊资源整合服务平台,搜索已发表的关于AD患者院内死亡危险因素的病例对照研究,检索时限为建库至2018年2月1日。按Cochrane系统评价方法筛选文献、提取资料并评价质量后,采用RevMan 5.3软件进行荟萃分析。结果纳入41篇病例对照研究,死亡组3353例,存活组19 927例。荟萃分析结果显示,女性(OR=1.13,95%CI 1.04～1.24,P=0.005)、年龄(WMD=0.92,95%CI 0.19～1.66,P=0.01)、马方综合征(OR=1.51,95%CI 1.13～2.00,P=0.005)、胸腔积液(OR=1.47,95%CI 1.22～1.77,P<0.001)、主动脉瓣关闭不全或反流(OR=2.65,95%CI 2.06～3.42,P<0.001)、心率(WMD=4.55,95%CI 2.38～6.71,P<0.01)、白细胞计数(WMD=1.99,95%CI 1.60～2.37,P<0.001)、中性粒细胞百分比(WMD=8.42,95%CI 7.28～9.55,P<0.001)、肌酐(WMD=57.74,95%CI 20.66～94.83,P=0.002)合并效应量后差异有统计学意义,是AD患者院内死亡的危险因素;介入治疗(OR=0.08,95%CI 0.06～0.11,P<0.001)合并效应量后差异有统计学意义,是AD患者院内死亡的保护因素。结论女性、年龄、马方综合征、胸腔积液、主动脉瓣关闭不全或反流、心率、白细胞计数、中性粒细胞百分比、肌酐是AD患者院内死亡的危险因素,介入治疗是保护因素。
Objective To explore associated risk factors of in-hospital death of patients with aortic dissection(AD) by meta-analysis. Methods A systematic literature review of case-control study on risk factors of in-hospital death of patients with AD published before February 1 th, 2018 was made in database of Cochrane Library, Elsevier ScienceDirect, PubMed/Medline, Wanfang data, CNKI and CQVIP. The literature was screened, the data was extracted and assessed using the Cochrane methods, and meta-analysis was performed by RevMan 5.3 software. Results Finally, 41 articles were included, involving 3353 cases of in-hospital deaths and 19 927 cases of in-hospital survival. Meta-analysis showed that female(OR=1.13, 95% CI 1.04-1.24, P=0.005), age(WMD=0.92, 95% CI 0.19-1.66, P=0.01), Marfan syndrome(OR=1.51, 95% CI 1.13-2.00, P=0.005), pleural effusion(OR=1.47, 95% CI 1.22-1.77, P<0.001), aortic incompetence or regurgitation(OR=2.65, 95% CI 2.06-3.42, P<0.001), heart rate(WMD=4.55, 95% CI 2.38-6.71, P<0.001), white blood cells(WMD=1.99, 95% CI 1.60-2.37, P<0.001), neutrophils percentage(WMD=8.42, 95% CI 7.28-9.55, P<0.001) and creatinine(WMD=57.74, 95% CI 20.66-94.83, P=0.002) were risk factors of in-hospital death for patients with AD, while interventional treatment(OR=0.08, 95% CI 0.06-0.11, P<0.001) was the protection factor. Conclusion Female, age, Marfan syndrome, pleural effusion, aortic incompetence or regurgitation, heart rate, white blood cells, neutrophils percentage and creatinine were risk factors of in-hospital death, while interventional treatment was the protection factor for patients with AD.
Objective To explore associated risk factors of in-hospital death of patients with aortic dissection(AD) by meta-analysis. Methods A systematic literature review of case-control study on risk factors of in-hospital death of patients with AD published before February 1 th, 2018 was made in database of Cochrane Library, Elsevier ScienceDirect, PubMed/Medline, Wanfang data, CNKI and CQVIP. The literature was screened, the data was extracted and assessed using the Cochrane methods, and meta-analysis was performed by RevMan 5.3 software. Results Finally, 41 articles were included, involving 3353 cases of in-hospital deaths and 19 927 cases of in-hospital survival. Meta-analysis showed that female(OR=1.13, 95% CI 1.04-1.24, P=0.005), age(WMD=0.92, 95% CI 0.19-1.66, P=0.01), Marfan syndrome(OR=1.51, 95% CI 1.13-2.00, P=0.005), pleural effusion(OR=1.47, 95% CI 1.22-1.77, P<0.001), aortic incompetence or regurgitation(OR=2.65, 95% CI 2.06-3.42, P<0.001), heart rate(WMD=4.55, 95% CI 2.38-6.71, P<0.001), white blood cells(WMD=1.99, 95% CI 1.60-2.37, P<0.001), neutrophils percentage(WMD=8.42, 95% CI 7.28-9.55, P<0.001) and creatinine(WMD=57.74, 95% CI 20.66-94.83, P=0.002) were risk factors of in-hospital death for patients with AD, while interventional treatment(OR=0.08, 95% CI 0.06-0.11, P<0.001) was the protection factor. Conclusion Female, age, Marfan syndrome, pleural effusion, aortic incompetence or regurgitation, heart rate, white blood cells, neutrophils percentage and creatinine were risk factors of in-hospital death, while interventional treatment was the protection factor for patients with AD.
引文
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[13] 金小岩,施旖旎,龙会宝,等. Stanford A型主动脉夹层急性期死亡危险因素分析[J].临床医学,2013,33(4):37-38.
[14] 孙惠萍,彭辉,马依彤,等. 新疆急性主动脉夹层患者653例临床特点及院内死亡危险因素分析[J].中华高血压杂志,2013,21(4):361-364.
[15] 李成国,李光勤,李品军,等. 100例Stanford B型主动脉夹层患者临床特征及危险因素分析[J].重庆医学,2014,43(33):4467-4471.
[16] 刘曌宇,柴博兰,邹远林,等. 482例主动脉夹层患者死亡因素的Logistic回归分析[J].华中科技大学学报(医学版),2014,43(6):697-700.
[17] 乔平. 931例主动脉夹层十年回顾性分析[D].武汉:华中科技大学,2014.
[18] 田力. 急性主动脉夹层患者住院死亡的预测因素和候选诊断生物标志物[D].北京:北京协和医学院,2014.
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[21] 王颢,张平平. 主动脉夹层急性期院内死亡相关危险因素分析[J].中国民族民间医药,2015,24(22):58-59.
[22] 张静.急性主动脉夹层患者的临床特征及院内死亡危险因素分析[D].合肥:安徽医科大学,2015.
[23] 朱德才,王利平,吴广福,等. 急性主动脉夹层患者的临床特征及死亡危险因素[J].中华高血压杂志,2015,23(9):883-886.
[24] 杜金勇. 主动脉夹层院内死亡相关危险因素分析[J].临床研究,2016,24(6):59-60.
[25] 乔平,曾和松,马建林,等. 主动脉夹层院内死亡危险因素十年回顾性分析[J].中国热带医学,2016,16(8):815-826.
[26] 苏运辉,叶大庆,罗程华. 主动脉夹层死亡危险因素分析及相应护理对策评价[J].岭南心血管病杂志,2016,22(4):478-498.
[27] 裕晓玲. 主动脉夹层的发病及死亡的相关因素的回顾性分析[D].长春:吉林大学,2016.
[28] 程宝山. 270例急性主动脉夹层患者临床特点和院内死亡危险因素分析[D].合肥:安徽医科大学,2017.
[29] 胡敏,吕强,刘惠亮,等. 急性主动脉夹层院内死亡的危险因素[J].中华高血压杂志,2017,25(4):345-349.
[30] 闫圣涛,周焕发,练睿,等. 急性主动脉夹层患者临床特征及住院期间死亡因素分析[J].中日友好医院学报,2017,31(3):131-134.
[31] Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type a aortic dissection[J].Circulation,2002,105(2):200-206.
[32] Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the international registry of aortic dissection (IRAD)[J].Circulation,2003,108(Suppl 1):S1312-1317.
[33] Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection[J].Heart,2013,99(16):1192-1197.
[34] Zhang J, Jing Y, Gao C, et al. Risk factors for hospital death in patients with acute aortic dissection[J].Heart Lung Circ,2015,24(4):348-353.
[35] Liang NL, Genovese EA, Al Khoury GE, et al. Effects of gender differences on short-term outcomes in patients with type B aortic dissection[J].Ann Vasc Surg,2017,38:78-83.
[36] Tian L, Fan X, Zhu J, et al. Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection[J].Blood Coagul Fibrinolysis,2014,25(2):161-166.
[37] Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection[J].Circulation,2004,109(24):3014-3021.
[38] 靖朋涛,杨琼. B型主动脉夹层危险因素分析[J].基层医学论坛,2014,18(14):1781-1783.
[39] 吴勇波,曾和松,黄芬,等. 主动脉夹层急性期院内死亡危险因素分析[J].内科急危重症杂志,2008,14(6):293-295.
[40] 赵新杰,王晓楠. 主动脉夹层患者住院死亡危险因素的临床分析[J].医学影像学杂志,2012,22(2):283-285.
[41] 熊玮,董少红. 急性主动脉夹层院内死亡的危险因素分析[J].中华高血压杂志,2011,19(6):584-586.
[42] Zhang R, Chen S, Zhang H, et al. Biomarkers investigation for in-hospital death in patients with stanford type A acute aortic dissection[J].Int Heart J,2016,57(5):622-626.
[43] Zhao L, Chai Y, Li Z. Clinical features and prognosis of patients with acute aortic dissection in China[J].J Int Med Res,2017,45(2):823-829.
[44] Tsai TT, Evangelista A, Nienaber CA, et al. Long-term survival in patients presenting with type a acute aortic dissection: insights from the international registry of acute aortic dissection (IRAD)[J].Circulation,2006,114(21):2226-2231.
[45] Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting meta-analysis of observational studies in epidemiology (MOOSE) group[J].JAMA,2000,283(15):2008-2012.
[2] Imamura H, Sekiguchi Y, Iwashita T, et al. Painless acute aortic dissection: diagnostic, prognostic and clinical implications[J].Circ J,2011,75(1):59-66.
[3] 张炜宗,马翔,王宝珠,等. 主动脉夹层患者院内死亡危险因素分析[J].中国全科医学,2017,20(30):3740-3744.
[4] Li Y, Yang N, Duan W, et al. Acute aortic dissection in China[J].Am J Cardiol,2012,110(7):1056-1061.
[5] Tolenaar JL, Froehlich W, Jonker FH, et al. Predicting in-hospital mortality in acute type B aortic dissection: evidence from international registry of acute aortic dissection[J].Circulation,2014,130(11 Suppl 1):S45-50.
[6] 郝明辉.急性主动脉夹层死亡的危险因素分析[D].乌鲁木齐:新疆医科大学,2010.
[7] 朱源生,陈忠.主动脉夹层患者住院死亡危险因素分析[J].心肺血管病杂志,2010,29(6):505-507.
[8] 王德鹏.主动脉夹层患者临床表现及住院死亡危险因素分析[D].武汉:华中科技大学,2011.
[9] 仇宝华,曹艳君,张红雨,等. Stanford A型主动脉夹层患者急性期死亡相关因素分析[J].青岛医药卫生,2012,44(4):265-267.
[10] 古丽巴哈,罗仁. 主动脉夹层临床特征及死亡危险因素分析[J].重庆医学,2012,41(20):2116-2118.
[11] 林淑梅,唐媛,徐国良,等. 主动脉夹层患者死亡相关因素分析[J].中国全科医学,2012,15(32):3714-3716.
[12] 陈运枝.主动脉夹层患者死亡的危险因素分析[J].医学综述,2013,19(22):4171-4173.
[13] 金小岩,施旖旎,龙会宝,等. Stanford A型主动脉夹层急性期死亡危险因素分析[J].临床医学,2013,33(4):37-38.
[14] 孙惠萍,彭辉,马依彤,等. 新疆急性主动脉夹层患者653例临床特点及院内死亡危险因素分析[J].中华高血压杂志,2013,21(4):361-364.
[15] 李成国,李光勤,李品军,等. 100例Stanford B型主动脉夹层患者临床特征及危险因素分析[J].重庆医学,2014,43(33):4467-4471.
[16] 刘曌宇,柴博兰,邹远林,等. 482例主动脉夹层患者死亡因素的Logistic回归分析[J].华中科技大学学报(医学版),2014,43(6):697-700.
[17] 乔平. 931例主动脉夹层十年回顾性分析[D].武汉:华中科技大学,2014.
[18] 田力. 急性主动脉夹层患者住院死亡的预测因素和候选诊断生物标志物[D].北京:北京协和医学院,2014.
[19] 陈水龙,郑剑涛,江宏飞,等. 主动脉夹层院内死亡相关危险因素分析[J].中国循证心血管医学杂志,2015,7(2):262-264.
[20] 马琛渊. 急性主动脉夹层患者的临床特点及死亡危险因素分析[D].温州:温州医科大学,2015.
[21] 王颢,张平平. 主动脉夹层急性期院内死亡相关危险因素分析[J].中国民族民间医药,2015,24(22):58-59.
[22] 张静.急性主动脉夹层患者的临床特征及院内死亡危险因素分析[D].合肥:安徽医科大学,2015.
[23] 朱德才,王利平,吴广福,等. 急性主动脉夹层患者的临床特征及死亡危险因素[J].中华高血压杂志,2015,23(9):883-886.
[24] 杜金勇. 主动脉夹层院内死亡相关危险因素分析[J].临床研究,2016,24(6):59-60.
[25] 乔平,曾和松,马建林,等. 主动脉夹层院内死亡危险因素十年回顾性分析[J].中国热带医学,2016,16(8):815-826.
[26] 苏运辉,叶大庆,罗程华. 主动脉夹层死亡危险因素分析及相应护理对策评价[J].岭南心血管病杂志,2016,22(4):478-498.
[27] 裕晓玲. 主动脉夹层的发病及死亡的相关因素的回顾性分析[D].长春:吉林大学,2016.
[28] 程宝山. 270例急性主动脉夹层患者临床特点和院内死亡危险因素分析[D].合肥:安徽医科大学,2017.
[29] 胡敏,吕强,刘惠亮,等. 急性主动脉夹层院内死亡的危险因素[J].中华高血压杂志,2017,25(4):345-349.
[30] 闫圣涛,周焕发,练睿,等. 急性主动脉夹层患者临床特征及住院期间死亡因素分析[J].中日友好医院学报,2017,31(3):131-134.
[31] Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type a aortic dissection[J].Circulation,2002,105(2):200-206.
[32] Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the international registry of aortic dissection (IRAD)[J].Circulation,2003,108(Suppl 1):S1312-1317.
[33] Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection[J].Heart,2013,99(16):1192-1197.
[34] Zhang J, Jing Y, Gao C, et al. Risk factors for hospital death in patients with acute aortic dissection[J].Heart Lung Circ,2015,24(4):348-353.
[35] Liang NL, Genovese EA, Al Khoury GE, et al. Effects of gender differences on short-term outcomes in patients with type B aortic dissection[J].Ann Vasc Surg,2017,38:78-83.
[36] Tian L, Fan X, Zhu J, et al. Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection[J].Blood Coagul Fibrinolysis,2014,25(2):161-166.
[37] Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection[J].Circulation,2004,109(24):3014-3021.
[38] 靖朋涛,杨琼. B型主动脉夹层危险因素分析[J].基层医学论坛,2014,18(14):1781-1783.
[39] 吴勇波,曾和松,黄芬,等. 主动脉夹层急性期院内死亡危险因素分析[J].内科急危重症杂志,2008,14(6):293-295.
[40] 赵新杰,王晓楠. 主动脉夹层患者住院死亡危险因素的临床分析[J].医学影像学杂志,2012,22(2):283-285.
[41] 熊玮,董少红. 急性主动脉夹层院内死亡的危险因素分析[J].中华高血压杂志,2011,19(6):584-586.
[42] Zhang R, Chen S, Zhang H, et al. Biomarkers investigation for in-hospital death in patients with stanford type A acute aortic dissection[J].Int Heart J,2016,57(5):622-626.
[43] Zhao L, Chai Y, Li Z. Clinical features and prognosis of patients with acute aortic dissection in China[J].J Int Med Res,2017,45(2):823-829.
[44] Tsai TT, Evangelista A, Nienaber CA, et al. Long-term survival in patients presenting with type a acute aortic dissection: insights from the international registry of acute aortic dissection (IRAD)[J].Circulation,2006,114(21):2226-2231.
[45] Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting meta-analysis of observational studies in epidemiology (MOOSE) group[J].JAMA,2000,283(15):2008-2012.