繼發性三尖瓣反流危險因素的Meta分析_《中國循證醫學雜志》

作者：

虞聰 ¹ ,  董念國 ¹ , 史嘉瑋 ¹ , 尹平 ²

1. 華中科技大學同濟醫學院附屬協和醫院心血管外科（武漢 430022）； 2. 華中科技大學同濟醫學院公共衛生學院流行病與衛生統計學系（武漢 430030）;

關鍵詞：

心臟瓣膜手術三尖瓣反流危險因素 Meta分析

DOI：

10.7507/1672-2531.20130253

視頻：

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目的　應用Meta分析方法探討左心瓣膜術（左心瓣膜置換或成形術，未同期行三尖瓣手術）術后繼發性三尖瓣反流（TR）的危險因素，為指導臨床診治提供依據。
方法　計算機檢索PubMed、MEDLINE、CBM、CNKI、VIP等，納入1995～2012年間有關左心瓣膜術后繼發性三尖瓣反流危險因素的文獻。根據納入與排除標準篩選文獻，提取資料和評價質量后采用RevMan 5.0軟件進行Meta分析。
結果　共納入6篇文獻，合計病例組437例，對照組2 102例。Meta分析結果顯示以下因素與左心瓣膜術后三尖瓣反流進行性加重相關：術前房顫［OR=3.90，95%CI（3.00，5.07）］、校正后術前房顫［OR=3.04，95%CI（2.21，4.16）］、年齡［MD=5.36，95%CI（3.49，7.23）］、大左房［OR=5.17，95%CI（3.12，8.57）］或左房內徑［MD=4.85，95%CI（3.18，6.53）］、校正后大左房［OR=1.91，95%CI（1.49，2.44）］、左心功能減低［OR=2.97，95%CI（1.73，5.08）］、風濕性病變［OR=3.06，95%CI（1.66，4.68）］、術前中度及以上TR［OR=3.52，95%CI（1.26，9.89）］和二尖瓣置換術（MVR）［OR= 2.35，95%CI（1.68，3.30）］。而性別［OR=1.54，95%CI（0.94，2.52）］，術前肺動脈高壓［OR=1.28，95%CI（0.77，2.12）］與左心瓣膜術后TR進行性加重不相關。
結論　影響左心瓣膜術后TR的危險因素包括術前房顫、年齡、大左房或左房內徑、左心功能減低、風濕性病變、術前中度及以上TR、二尖瓣置換術。了解這些危險因素對防治左心瓣膜術后TR的遠期療效有一定指導意義。

引用本文： 虞聰,董念國,史嘉瑋,尹平. 繼發性三尖瓣反流危險因素的Meta分析. 中國循證醫學雜志, 2013, 13(12): 1482-1491. doi: 10.7507/1672-2531.20130253 復制

1.	Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1): 80-86.
2.	Fukuda N, Oki T, Iuchi A, et al. Tricuspid inflow and regurgitant flow dynamics after mitral valve replacement: differences relating to surgical repair of the tricuspid valve. J Heart Valve Dis, 1997, 6(2): 184-188.
3.	Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8(1): 57-62.
4.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studied in meta-analysis. http://www.ohri.ca/programs/clinical.Epide-miology/oxford.htm(accessed March 2005).
5.	王國華, 孫宗全, 張凱倫, 等. 繼發性三尖瓣反流危險因素分析及外科治療. 中華胸心血管外科雜志, 2007, 23(6): 374-377.
6.	魏丹, 孟旭, 李巖, 等. 左心瓣膜術后心房顫動與三尖瓣反流的關系. 心肺血管病雜志, 2012, 31(1):36-39.
7.	Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg, 2003, 75(6): 1826-1828.
8.	Kwak JJ, Kim YJ, Kim MK. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4):732-737.
9.	Song H, Kim MJ, Chung CH, et al. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart, 2009, 11(11): 931-936.
10.	García Fuster R, Vázquez A, Peláez AG, et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation. Eur J Cardiothorac Surg, 2011, 39(6): 866-874.
11.	Vickers A, Goyal N, Harland R, et al. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials, 1998, 19(2): 159-166.
12.	麥勁壯, 李河, 方積乾, 等. Meta分析中失安全系數的估計. 循證醫學, 2006, 6(5): 297-303.
13.	Raja SG, Dreyfus GD. Basis for Intervention on Functional tricuspid Regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
14.	Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35(Suppl 4): I63-69.
15.	Simon R, Oelert H, Borst HG, et al. Influence of mitral valve surgery on tricuspid incompetence concomitant with mitral valve disease. Circulation, 1980, 62(2): 152-157.
16.	Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11(2): 353-356.
17.	Kim HK, Kim YJ, Kim KI, et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation, 2005, 112( Suppl 9): I14-19.
18.	Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2): 271-276.
19.	Benjamin EJ, D’Agostino RB, Belanger AJ, et al. Left atrial size and the risk of stroke and death. The Framingham heart study. Circulation, 1995, 92(4): 835-841.
20.	Stulak JM, Schaff HV, Dearani JA, et al. Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. Ann Thorac Surg, 2008, 86(1): 40-45.
21.	Xiao XJ, Huang HL, Zhang JF, et al. Surgical Treatment of Late Tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1): 65-69.
22.	Kaul TK, Ramsdale DR, Mercer JL. Functional tricuspid regurgitation following replacement of the mitral valve. Int J Cardiol, 1991, 33(2): 305-313.

1. Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1): 80-86.
2. Fukuda N, Oki T, Iuchi A, et al. Tricuspid inflow and regurgitant flow dynamics after mitral valve replacement: differences relating to surgical repair of the tricuspid valve. J Heart Valve Dis, 1997, 6(2): 184-188.
3. Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8(1): 57-62.
4. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studied in meta-analysis. http://www.ohri.ca/programs/clinical.Epide-miology/oxford.htm(accessed March 2005).
5. 王國華, 孫宗全, 張凱倫, 等. 繼發性三尖瓣反流危險因素分析及外科治療. 中華胸心血管外科雜志, 2007, 23(6): 374-377.
6. 魏丹, 孟旭, 李巖, 等. 左心瓣膜術后心房顫動與三尖瓣反流的關系. 心肺血管病雜志, 2012, 31(1):36-39.
7. Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg, 2003, 75(6): 1826-1828.
8. Kwak JJ, Kim YJ, Kim MK. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4):732-737.
9. Song H, Kim MJ, Chung CH, et al. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart, 2009, 11(11): 931-936.
10. García Fuster R, Vázquez A, Peláez AG, et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation. Eur J Cardiothorac Surg, 2011, 39(6): 866-874.
11. Vickers A, Goyal N, Harland R, et al. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials, 1998, 19(2): 159-166.
12. 麥勁壯, 李河, 方積乾, 等. Meta分析中失安全系數的估計. 循證醫學, 2006, 6(5): 297-303.
13. Raja SG, Dreyfus GD. Basis for Intervention on Functional tricuspid Regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
14. Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35(Suppl 4): I63-69.
15. Simon R, Oelert H, Borst HG, et al. Influence of mitral valve surgery on tricuspid incompetence concomitant with mitral valve disease. Circulation, 1980, 62(2): 152-157.
16. Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11(2): 353-356.
17. Kim HK, Kim YJ, Kim KI, et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation, 2005, 112( Suppl 9): I14-19.
18. Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2): 271-276.
19. Benjamin EJ, D’Agostino RB, Belanger AJ, et al. Left atrial size and the risk of stroke and death. The Framingham heart study. Circulation, 1995, 92(4): 835-841.
20. Stulak JM, Schaff HV, Dearani JA, et al. Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. Ann Thorac Surg, 2008, 86(1): 40-45.
21. Xiao XJ, Huang HL, Zhang JF, et al. Surgical Treatment of Late Tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1): 65-69.
22. Kaul TK, Ramsdale DR, Mercer JL. Functional tricuspid regurgitation following replacement of the mitral valve. Int J Cardiol, 1991, 33(2): 305-313.

《中國循證醫學雜志》

繼發性三尖瓣反流危險因素的Meta分析

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《中國循證醫學雜志》

繼發性三尖瓣反流危險因素的Meta分析

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