摘要
目的研究缺血后适应对急性ST段抬高型心肌梗死(STEMI)患者心脏结构及功能的影响。方法全面检索Medline、Embase、the Cochrane Central Register of Controlled Trials、中国生物医学文献数据库、中国知网、万方数据库及维普期刊数据库,检索时间为从建库至2018年4月30日。主要结局指标为最终梗死面积、左心室射血分数,次要结局指标为心肌水肿程度、心肌挽救指数、微循环障碍发生率、左心室舒张末期容积。以上所有指标均通过心脏核磁共振成像评估及量化。结果共有12个研究纳入Meta分析。对于STEMI患者,冠状动脉内缺血后适应联合经皮冠状动脉介入治疗(PCI)与单纯PCI相比,可以显著减少最终心肌梗死面积(SMD–0.19,95%CI–0.38～0.00,P=0.048),可以显著增加左心室射血分数(WMD 1.62,95%CI0.39～2.85,P=0.010)及心肌挽救指数(WMD 3.69,95%CI0.25～7.13,P=0.035),有降低心肌水肿的趋势(SMD–0.18,95%CI–0.38～0.01,P=0.057),但未能显著降低微循环障碍发生率(RR 0.98,95%CI 0.84～1.14,P>0.05),未能减小左心室舒张末期容积(WMD–0.15,95%CI–3.05～2.74,P>0.05)。结论对于STEMI患者,缺血后适应联合PCI可以降低最终梗死面积、增加左心室射血分数及心肌挽救指数,并有降低心肌水肿的趋势,对心脏有显著保护作用,但未能降低微循环障碍发生率及左心室舒张末期容积。
Objective This meta analysis is aimed to summarize the evidence from randomized controlled clinical trials examining the efficacy of ischemic postconditioning on cardiac structure and function, which were measured by cardiac magnetic resonance, in patients with acute ST-segment elevation myocardial infarction. Methods Databases including Medline, Embase, the Cochrane Central Register of Controlled Trials, CBM, China National Knowledge Infrastructure(CNKI), WanFang and VIP databases were systematically searched, from onset to April 2018.Final ischemic size(IS), left ventricular ejection fraction(LVEF) were selected as the primary outcomes, and myocardial salvage index(MSI), the extent of myocardial edema(ME), LVend diastolic volume(LVEDV), the incidence of microvascular obstruction(MVO) were the secondary outcomes. All of the outcomes were estimated and quantified by cardiac magnetic resonance.Results Twelve randomized controlled trials were included in our meta analysis. Compared with conventional PCI, ischemic postconditoning obtained better results in terms of IS(SMD –0.19,95%CI –0.38～0.00, P=0.048),LVEF(WMD 1.62,95%CI 0.39～2.85,P=0.010) and MSI(WMD3.69,95%CI 0.25～7.13,P=0.035). There was a trend toward decreased myocardial edema in the ischemic postconditioning group, which showed no statistical significance(SMD –0.18,95%CI–0.38～0.01,P=0.057). No significant dif ference was found in the two groups in terms of the incidence of MVO(RR 0.98,95%CI 0.84～1.14,P>0.05), and LVEDV(WMD –0.15,95%CI –3.05～2.74,P>0.05). Conclusions Ischemic postconditioning yielded favorable outcomes in terms of cardioprotection as evidenced by decreased IS, the extent of myocardial edema, and improved LVEF, MSI without af fecting the incidence of MVO, LVEDV in patients with STEMI.
引文
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