摘要
目的通过系统评价和Meta分析,对比旁路移植手术与保守治疗对成人症状性烟雾病患者远期脑血管事件风险的预防效果。方法根据检索策略,对Pub Med、EMbase、Cochrane Library等数据库进行检索,获得采用旁路移植手术与保守治疗成人症状性烟雾病患者远期脑血管事件风险的文献,检索时间从建库至2018年7月。由两名独立研究者根据纳入、排除标准进行筛选、评价文献和提取数据。观察结局为旁路移植手术和保守治疗患者的远期(随访12个月以上)缺血和出血事件。根据临床症状分为出血型和缺血型烟雾病两个亚组,并记录各亚组相应的缺血及出血事件。采用I2评价文献异质性,根据I2<50%或I2≥50%,分别选择固定效应模型或随机效应模型,对异质性较大者(I2> 70%)进行亚组分析,包括症状类型(出血型、缺血型成人烟雾病)和研究类型(前瞻性、回顾性)亚组。分别对患者例数和治疗例次数进行统计。使用Rev Man 5.3软件对数据进行分析,纽卡斯尔-渥太华量表(NOS)评价文献质量,漏斗图评价发表偏倚的风险。结果从2 159篇文献中最终纳入8篇(成人症状性烟雾病患者共1 160例),其中回顾性队列研究6篇,前瞻性队列研究1篇,随机对照试验1篇;以患者例数统计的文献6篇,以治疗例次统计的文献2篇。NOS评价结果显示,文献为中高等质量(NOS> 5分)。(1)与保守治疗比较,旁路移植手术可以显著降低成人症状性烟雾病患者远期缺血和出血事件的发生风险(缺血事件:OR=0.53,95%CI:0.33~0.85,P=0.008;出血事件:OR=0.38,95%CI:0.23~0.64,P=0.0003)。(2)在成人症状性烟雾病的亚组分析中,对于缺血型烟雾病患者,其远期缺血事件具有较大的异质性(I2=71%),无法进一步分析,但旁路移植手术的远期出血风险明显低于保守治疗(OR=0.39,95%CI:0.18~0.87,P=0.02);对于出血型烟雾病患者,旁路移植手术的远期缺血和出血风险均低于保守治疗(�
Objective To evaluate the efficacy of bypass surgery on preventing long-term cerebrovascular events in adult patients with symptomatic Moyamoya disease( MMD) compared with conservative treatment.Methods We searched the databases of PubMed,EMbase,and Cochrane Library with the retrieval time from building the database to July 2018.Two independent researchers screened,evaluated the literature and extracted the data based on the criteria of inclusion and exclusion.The patients with MMD were divided into ischemic type and hemorrhagic type referred to the index symptom.The primary outcome in both bypass surgery group and conservative treatment group was long-term( >12 months) ischemic and hemorrhagic event.A fixed-effects model or random-effects model was adopted based on the heterogeneity( I^2).For results with high heterogeneity( I2> 70%),the interpretation was expected to the subgroup analysis.The Newcastle-Ottawa scale( NOS) and funnel plot were utilized to assess the risk of bias.Results A total of eight studies were included through screening of 2 159 studies,including1 randomized controlled trial( RCT),1 prospective cohort,and 6 retrospective cohorts,with 1 160 adult patients with symptomatic MMD.Bypass surgery significantly reduced the ischemic and hemorrhagic risk compared with conservative treatment in adult patients with symptomatic MMD( OR,0.53,95% CI 0.33-0.85,P = 0.008;OR,0.38,95% CI 0.23-0.64,P = 0.0003,respectively).For patients with ischemic MMD,the long-term outcome of ischemic events were unavailable for analysis due to high heterogeneity,while the hemorrhagic risk significantly decreased in the surgery group( OR,0.39,95% CI 0.18-0.87,P =0.02).For patients with hemorrhagic MMD,both long-term ischemic and hemorrhagic events decreased in the surgery group compared with conservative treatment group( ischemic event: OR,0.16,95% CI 0.06-0.43,P = 0.0004;hemorrhagic event: OR,0.39,95% CI 0.18-0.84,P = 0.02).There was no evidence of publication bias according to NOS and funnel plot.Conclusions Bypass surgery
作者
贾赫尘
王韬
焦力群
马妍
Jia Hechen;Wang Tao;Jiao Liqun;Ma Yan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2020年第8期436-445,共10页
Chinese Journal of Cerebrovascular Diseases
基金
国家重点研发计划(2016YFC1301703)
北京市科技计划(D161100003816002)。
