脈旁路移植術后心肌損傷標記物對術后死亡率影響的Meta分析_《中國循證醫學雜志》

作者：

李瑾 , 鄭宏

新疆醫科大學第一附屬醫院麻醉科（烏魯木齊市 830054）;

關鍵詞：

冠脈移植旁路術心肌損傷標記物肌酸激酶同工酶肌鈣蛋白I Meta分析

DOI：

10.7507/1672-2531.20120138

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目的　系統評價冠脈旁路移植術術后心肌損傷標記物對術后短期、長期死亡率的影響。
方法　計算機檢索Cochrane Library、PubMed、EMbase、Ovid、CNKI、VIP、WanFang Data，檢索時間均從建庫至2011年8月，手工檢索相關雜志并追索納入文獻的參考文獻。納入冠脈旁路移植術后心肌損傷標記物［肌酸激酶同工酶（CK-MB）和肌鈣蛋白I（cTnI）］對術后死亡率影響的隊列和病例對照研究，由兩位評價員按照納入排除標準獨立進行資料提取、質量評價并交叉核對后，采用RevMan 5.0軟件進行Meta分析。
結果　納入10個隊列研究，共10 793例患者。Meta分析結果顯示：無論體外循環冠脈搭橋術（on-pump）或非體外循環冠脈搭橋術（off pump），CK-MB增高組術后短期死亡率均比CK-MB非增高組高，兩組差異有統計學意義［RR=2.88，95%CI（1.94，4.28）， P lt;0.000 01；RR=3.64，95%CI（1.07，12.42），P=0.04］。無論on-pump或off pump，CK-MB增高組術后長期死亡率均比CK-MB非增高組高，兩組差異有統計學意義［RR=2.55，95%CI（1.91，3.40），P lt;0.000 01；RR=3.36，95%CI（1.46，7.72），P=0.004］。cTnI測定值增高組術后短期及長期死亡率比非增高組高［RR=6.45，95%CI（2.50，16.66），P=0.000 1；RR=4.18，95%CI（2.78，6.28），P lt;0.000 01］。
結論　現有證據表明，冠脈移植旁路術后肌酸激酶同工酶（CK-MB）、肌鈣蛋白I（cTnI）測定值增高與術后短期及長期死亡率增高相關。

引用本文： 李瑾,鄭宏. 脈旁路移植術后心肌損傷標記物對術后死亡率影響的Meta分析. 中國循證醫學雜志, 2012, 12(7): 777-784. doi: 10.7507/1672-2531.20120138 復制

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2.	Malic V, Kale SC, Chowdhury UK, et al. Myocardial injury in coronary artery bypass grafting－on-pump versus off-pump comparison by measuring heart-type fatty-acid-binding protein release. Tex Heart Inst, 2006, 33(3): 321-327.
3.	Shim JK, Chio SH, Oh YJ, et al. The effect of mannitol on oxygenation and creatine kinase MB release in patients undergoing multivessel off-pump coronary artery bypass surgery. Thorac Cardiovasc Surg, 2007, 133(7): 704-709.
4.	Rastan AJ, Bittner HB, Gummert JF, et al. On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury. Eur Cardiothorac Surg, 2005, 27(45): 1057-1064.
5.	Thielmann M, Massoudy P, Neuhauser M, et al. Diagnostic discrimination between graft -related perioperative myocardial infarction with cardiactroponin I after coronary artery bypass surgery. European Heart, 2005, 26(12): 2440-2447.
6.	Miyahara K, Matsuura A, Takemura H, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. Thorac J Cardiovasc Surg, 2008, 135(8): 521-526.
7.	Steuer J, Horte LG, Lindahl B, et al. Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting. Eur Heart, 2002, 23(6): 1219-1227.
8.	楊振華, 潘柏中. 中華醫學會檢驗學會文件心肌損傷標志物的應用準則. 中華檢驗醫學雜志, 2002, 25(3): 185-189.
9.	2006 Cochrane handbook for systematic reviews of intervention. The Cochrane Library. Oxford, UK: Update Software.
10.	Stroup DF, Brtlin 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. JAMA, 2000, 283(15): 2008-2012.
11.	Wells GA, Shea B, O’Connell D. Newcastle-Ottawascale. 2006, Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
12.	Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable State in Cushing’s Syndrome: A Systematic Review. J Clin Endocrinol Metab, 2009, 94(12): 2743-2750.
13.	Ramsay J, Shernan S, Fitch J, et al. Increased creatine kinase MB level predicts postoperative mortality after cardiac surgery independent of new Q waves. Thorac Cardiovasc Surg, 2005, 129(6): 300-306.
14.	Mahaffey KW, Roe MT, Kilaru R, et al. Creatine kinase-MB elevation after coronary artery bypass grafting surgery in patients with non-ST-segment elevation acute coronary syndromes predict worse outcomes: results from four large clinical trials. Eur Heart, 2007, 28(4): 425-432.
15.	Engoren MC, Habib RH, Zacharias A, et al. The association of elevated creatine kinase-myocardial band on mortality after coronary artery bypass grafting surgery is time and magnitude limited. Eur J Cardiothorac Surg, 2005, 28(5): 114-119.
16.	Kuduvalli M, Newall N, Stott A, et al. Impact of avoiding cardiopulmonary bypass for coronary surgery on perioperative cardiac enzyme release and survival. Eur J Cardiothorac Surg, 2006, 29(5): 729-735.
17.	Paparella D, Cappabianca G, Malvindi P, et al. Myocardial injury after off-pump coronary artery bypass grafting operation. Eur J Cardiothorac Surg, 2007, 32(7): 481-487.
18.	Fellahi J, Gue X, Richomme X, et al. Short- and long-term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology, 2003, 99(18): 270-274.
19.	Paparella D, Cappabianca G, Visicchio G, et al. Cardiac troponin I release after coronary artery bypass grafting operation: effects on operative and midterm survival. Ann Thorac Surg, 2005, 80(12): 1758-1764.
20.	Croal BL, Hillis GS, Gibson PH, et al. Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation, 2006, 114(3): 1468 -1475.
21.	Onorati F, De Feo M, Mastroroberto P, et al. Determinants and prognosis of myocardial damage after coronary artery bypass grafting. Ann Thorac Surg, 2005, 79(7): 837- 845.
22.	Van Geene Y, van Swieten HA, Noyez L, et al. Cardiac troponin I levels after cardiac surgery as predictor for in-hospital mortality. Interact CardioVasc Thorac Surg, 2010, 10(2): 413-416.
23.	沈洪兵. 循證醫學. 見: 姜慶五, 主編. 臨床流行病學. 第1版. 北京: 高等教育出版社, 2007: 240-250.
24.	Fellahi J, Hedoire F, Le Manach Y, et al. Determination of the threshold of cardiac troponin I associated with an adverse postoperative outcome after cardiac surgery: a comparative study between coronary artery bypass graft, valve surgery, and combined cardiac surgery. Crit Care, 2007, 11: R106. Available from: URL: http:// ccforum.com/content/11/5/R106.
25.	Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth, 2006, 97(6): 127-136.

1. DT Mangano, Multicenter Study of Perioperative Ischemia (MCSPI) Research Group. Effects of acadesine on the incidence of myocardial infarction and adverse cardiac outcomes after coronary artery bypass graft surgery. Anesthesiology, 1995, 83(15): 658-673.
2. Malic V, Kale SC, Chowdhury UK, et al. Myocardial injury in coronary artery bypass grafting－on-pump versus off-pump comparison by measuring heart-type fatty-acid-binding protein release. Tex Heart Inst, 2006, 33(3): 321-327.
3. Shim JK, Chio SH, Oh YJ, et al. The effect of mannitol on oxygenation and creatine kinase MB release in patients undergoing multivessel off-pump coronary artery bypass surgery. Thorac Cardiovasc Surg, 2007, 133(7): 704-709.
4. Rastan AJ, Bittner HB, Gummert JF, et al. On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury. Eur Cardiothorac Surg, 2005, 27(45): 1057-1064.
5. Thielmann M, Massoudy P, Neuhauser M, et al. Diagnostic discrimination between graft -related perioperative myocardial infarction with cardiactroponin I after coronary artery bypass surgery. European Heart, 2005, 26(12): 2440-2447.
6. Miyahara K, Matsuura A, Takemura H, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. Thorac J Cardiovasc Surg, 2008, 135(8): 521-526.
7. Steuer J, Horte LG, Lindahl B, et al. Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting. Eur Heart, 2002, 23(6): 1219-1227.
8. 楊振華, 潘柏中. 中華醫學會檢驗學會文件心肌損傷標志物的應用準則. 中華檢驗醫學雜志, 2002, 25(3): 185-189.
9. 2006 Cochrane handbook for systematic reviews of intervention. The Cochrane Library. Oxford, UK: Update Software.
10. Stroup DF, Brtlin 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. JAMA, 2000, 283(15): 2008-2012.
11. Wells GA, Shea B, O’Connell D. Newcastle-Ottawascale. 2006, Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
12. Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable State in Cushing’s Syndrome: A Systematic Review. J Clin Endocrinol Metab, 2009, 94(12): 2743-2750.
13. Ramsay J, Shernan S, Fitch J, et al. Increased creatine kinase MB level predicts postoperative mortality after cardiac surgery independent of new Q waves. Thorac Cardiovasc Surg, 2005, 129(6): 300-306.
14. Mahaffey KW, Roe MT, Kilaru R, et al. Creatine kinase-MB elevation after coronary artery bypass grafting surgery in patients with non-ST-segment elevation acute coronary syndromes predict worse outcomes: results from four large clinical trials. Eur Heart, 2007, 28(4): 425-432.
15. Engoren MC, Habib RH, Zacharias A, et al. The association of elevated creatine kinase-myocardial band on mortality after coronary artery bypass grafting surgery is time and magnitude limited. Eur J Cardiothorac Surg, 2005, 28(5): 114-119.
16. Kuduvalli M, Newall N, Stott A, et al. Impact of avoiding cardiopulmonary bypass for coronary surgery on perioperative cardiac enzyme release and survival. Eur J Cardiothorac Surg, 2006, 29(5): 729-735.
17. Paparella D, Cappabianca G, Malvindi P, et al. Myocardial injury after off-pump coronary artery bypass grafting operation. Eur J Cardiothorac Surg, 2007, 32(7): 481-487.
18. Fellahi J, Gue X, Richomme X, et al. Short- and long-term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology, 2003, 99(18): 270-274.
19. Paparella D, Cappabianca G, Visicchio G, et al. Cardiac troponin I release after coronary artery bypass grafting operation: effects on operative and midterm survival. Ann Thorac Surg, 2005, 80(12): 1758-1764.
20. Croal BL, Hillis GS, Gibson PH, et al. Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation, 2006, 114(3): 1468 -1475.
21. Onorati F, De Feo M, Mastroroberto P, et al. Determinants and prognosis of myocardial damage after coronary artery bypass grafting. Ann Thorac Surg, 2005, 79(7): 837- 845.
22. Van Geene Y, van Swieten HA, Noyez L, et al. Cardiac troponin I levels after cardiac surgery as predictor for in-hospital mortality. Interact CardioVasc Thorac Surg, 2010, 10(2): 413-416.
23. 沈洪兵. 循證醫學. 見: 姜慶五, 主編. 臨床流行病學. 第1版. 北京: 高等教育出版社, 2007: 240-250.
24. Fellahi J, Hedoire F, Le Manach Y, et al. Determination of the threshold of cardiac troponin I associated with an adverse postoperative outcome after cardiac surgery: a comparative study between coronary artery bypass graft, valve surgery, and combined cardiac surgery. Crit Care, 2007, 11: R106. Available from: URL: http:// ccforum.com/content/11/5/R106.
25. Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth, 2006, 97(6): 127-136.

《中國循證醫學雜志》

脈旁路移植術后心肌損傷標記物對術后死亡率影響的Meta分析

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《中國循證醫學雜志》

脈旁路移植術后心肌損傷標記物對術后死亡率影響的Meta分析

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