闫丹丹, 邵珲, 杜亚娟, 张玉顺. 卵圆孔未闭封堵治疗隐源性脑卒中预防复发效果的meta分析[J]. 心脏杂志, 2019, 30(1): 57-64. DOI: 10.12125/j.chj.201804034
    引用本文: 闫丹丹, 邵珲, 杜亚娟, 张玉顺. 卵圆孔未闭封堵治疗隐源性脑卒中预防复发效果的meta分析[J]. 心脏杂志, 2019, 30(1): 57-64. DOI: 10.12125/j.chj.201804034
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    Dan-dan YAN, Hui SHAO, Ya-juan DU, Yushun Zhang. Percutaneous patent foramen ovale closure in prevention of recurrence of cryptogenic stroke: A meta-analysis[J]. Chinese Heart Journal, 2019, 30(1): 57-64. DOI: 10.12125/j.chj.201804034
    Citation: Dan-dan YAN, Hui SHAO, Ya-juan DU, Yushun Zhang. Percutaneous patent foramen ovale closure in prevention of recurrence of cryptogenic stroke: A meta-analysis[J]. Chinese Heart Journal, 2019, 30(1): 57-64. DOI: 10.12125/j.chj.201804034
    shu

    卵圆孔未闭封堵治疗隐源性脑卒中预防复发效果的meta分析

    Percutaneous patent foramen ovale closure in prevention of recurrence of cryptogenic stroke: A meta-analysis

      摘要
    • 摘要:
        目的   卵圆孔未闭（PFO）封堵治疗隐源性脑卒中效果的meta分析。
        方法   通过Web of Science，EMBASE，PubMed和Cochrane图书馆等数据库进行了以药物对照的随机对照试验的相关检索。主要终点是复发性卒中和短暂性脑缺血发作（TIA）。 提取原始数据、风险比（HR）及95%置信区间（95%CI）的数值用以计算汇总效应大小。
        结果   Meta分析发现，在PFO患者缺血性脑卒中和（或）TIA的预防上，在意向性人群中封堵器组要明显优于药物治疗组（HR = 0.47，95% CI: 0.27-0.84，I2 = 55.4%，P<0.01）。随访期间封堵器组的全因死亡率较药物治疗组差异无统计学意义（OR = 0.83，95% CI: 0.37 - 1.85，I2 = 21.8%，P = 0.655）。在封堵器组患者中，发生新发房颤的风险较药物治疗组显著增加（OR = 5.44，95% CI: 2.92 - 10.15，I2 = 35.3%，P<0.01）。meta分析结果亦表明，在大量分流的患者中，经封堵器治疗后，卒中的复发率较药物治疗组显著减少（OR = 0.31，95% CI: 0.14 - 0.69，I2=0，P < 0.01）。而在与药物治疗相比中，PFO并发房间隔膨出瘤（ASA）的患者亦明显受益于封堵器治疗（OR = 0.44，95% CI: 0.23-0.81，I 2 = 63.3%，P<0.01）。
        结论   与单纯药物治疗相比,PFO封堵治疗隐匿性脑卒中患者复发脑卒中的风险明显减低。在有大量分流和房间隔膨出瘤的患者中，PFO封堵的获益更大。PFO的封堵与新发心房颤动的发生率较高有关。

       

      Abstract:
        AIM   AIM A meta-analysis was performed using randomized controlled trials on efficacy of transcatheter PFO closure in patients with cryptogenic stroke.
        METHODS   Web of Science, EMBASE, PubMed, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) with medical therapy as control. The primary outcome was recurrent stroke and transient-ischemic attack (TIA). Original data, hazard ratio (HR) with 95% confidence interval (95%CI) were abstracted to calculate a pooled effect size.
        RESULTS   The meta-analysis showed benefit with device closure when compared with medical therapy with an HR of 0.47(95%CI:0.27-0.84, P<0.01) in the intention-to-treat cohort. There was no significant difference with respect to the all-cause mortality between the device closure and the drug treatment during the follow-up (OR=0.83, 95%CI: 0.37-1.85, I2=21.8%, P=0.655). There was a significantly higher incidence of new-onset atrial fibrillation in PFO closure patients (OR=5.44,95%CI: 2.92-10.15, I2=35.3%, P<0.01). Patients with a substantial PFO shunt benefit the greatest with device closure with a pooled OR of 0.31 (95%CI: 0.14-0.69, I2=0, P<0.01). PFO Patients with an atrial septal aneurysm benefit from device closure (OR=0.44, 95%CI: 0.23-0.81, I2=63.3%, P<0.01).
        CONCLUSION   The meta-analysis concluded that PFO closure was associated with significantly lower risk of recurrent stroke in PFO patients with cryptogenic stroke than with medical therapy alone. The benefit of PFO closure was greater in patients with a substantial shunt and atrial septal aneurysm. PFO closure was associated with higher rates of new-onset atrial fibrillation.

       

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