文献类型：期刊文献

中文题名：胸主动脉腔内修复术对比药物和外科手术治疗B型主动脉夹层的死亡率和生存率的系统评价和Meta分析

英文题名：Comparison in mortality and survival rate among thoracic endovascular aortic repair,medication and surgery for type B aortic dissection:A systematic review and Meta-analysis

作者：金刚[1];李超[2];王薇[2];唐恩琪[2];神兴伟[3];刘娇娇[2];黄颖[3];朱自江[1]

第一作者：金刚

机构：[1]甘肃省人民医院胸外二科,兰州730099;[2]甘肃中医药大学,兰州730000;[3]兰州大学第二临床医学院,兰州730030

第一机构：甘肃省人民医院胸外二科,兰州730099

年份：2023

卷号：15

期号：1

起止页码：3

中文期刊名：中国循证心血管医学杂志

外文期刊名：Chinese Journal of Evidence-Based Cardiovascular Medicine

收录：CSTPCD

基金：国家自然科学基金项目(31760259)。

语种：中文

中文关键词：B型主动脉夹层;胸主动脉腔内修复术;药物治疗;外科手术;Meta分析

外文关键词：Type B aortic dissection;Thoracic endovascular aortic repair;Medication;Surgery;Meta-analysis

摘要：目的系统评价胸主动脉腔内修复术(TEVAR)对比药物和外科手术治疗B型主动脉夹层的生存率和死亡率。方法计算机检索Cochrane Library、PubMed、EMbase、Web of Science、CBM、WanFang、VIP和CNKI数据库,搜集所有TEVAR对比外科手术和药物治疗B型主动脉夹层的病例对照研究,检索时限均从建库至2021年6月20日。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入18项研究,Meta分析结果显示:TEVAR对比外科手术可降低B型主动脉夹层患者的30 d死亡率(OR=0.25,95%CI:0.08~0.75,P=0.01);在中远期死亡率和生存率方面,两种治疗方式无差异(1年死亡率:OR=0.65,95%CI:0.31~1.40;3年死亡率:OR=0.43,95%CI:0.12~1.46;5年死亡率:OR=1.40,95%CI:0.78~2.51;1年生存率:OR=1.49,95%CI:0.66~3.32;3年生存率:OR=2.34,95%CI:0.69~8.02;5年生存率:OR=0.83,95%CI:0.45~1.54)。比较TEVAR和药物治疗B型主动脉夹层患者,死亡率和生存率均无差异(30 d死亡率:OR=1.12,95%CI:0.66~1.89;1年死亡率:OR=1.49,95%CI:0.70~3.16;2年死亡率:OR=1.14,95%CI:0.58~2.23;3年死亡率:OR=0.66,95%CI:0.29~1.52;5年死亡率:OR=1.13,95%CI:0.50~2.57;30 d生存率:OR=0.81,95%CI:0.04~17.19;1年生存率:OR=0.67,95%CI:0.32~1.42;3年生存率:OR=0.88,95%CI:0.39~2.01;5年生存率:OR=1.51,95%CI:0.66~3.45)。结论TEVAR对比外科手术可降低B型主动脉夹层患者的30 d死亡率,其结论仍需高质量、大样本研究进一步证实。
Objective To systematically review the comparison in mortality and survival rate among thoracic endovascular aortic repair(TEVAR),medication and surgery for type B aortic dissection.Methods The databases of Cochrane Library,PubMed,EMbase,Web of Science,CBM,WanFang Data,VIP Database and CNKI were retrieved with computer to collect the case-control studies on comparison in TEVAR,surgery and drugs from database establishment time to June 20,2021.The literature was screened,data was extracted and bias risk was reviewed by 2 researchers independently.A Meta-analysis was conducted by using RevMan 5.3 software.Results There were totally 18 studies included.The results of Meta-analysis showed that TEVAR reduced 30-d mortality compared with surgery(OR=0.25,95%CI:0.08~0.75,P=0.01)in patients with type B aortic dissection.In terms of long-term mortality and survival rate,there was no difference between TEVAR and surgery(1-y mortality:OR=0.65,95%CI:0.31~1.40;3-y mortality:OR=0.43,95%CI:0.12~1.46,5-y mortality:OR=1.40,95%CI:0.78~2.51;1-y survival rate:OR=1.49,95%CI:0.66~3.32;3-y survival rate:OR=2.34,95%CI:0.69~8.02,5-y survival rate:OR=0.83,95%CI:0.45~1.54).The comparison between TEVAR and medication showed that there were no differences in mortality and survival rate(30-d mortality:OR=1.12,95%CI:0.66~1.89,1-y mortality:OR=1.49,95%CI:0.70~3.16;2-y mortality:OR=1.14,95%CI:0.58~2.23),3-y mortality:OR=0.66,95%CI:0.29~1.52,5-y mortality:OR=1.13,95%CI:0.50~2.57);30-d survival rate:OR=0.81,95%CI:0.04~17.19,1-y survival rate:OR=0.67,95%CI:0.32~1.42,3 y survival rate:OR=0.88,95%CI:0.39~2.01,5-y survival rate:OR=1.51,95%CI:0.66~3.45).Conclusion TEVAR can reduce 30-d mortality in patients with type B aortic dissection compared with surgery,but the conclusion still needs to be confirmed by high-quality and large-sample studies.