颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析

摘要

目的 系统评价颅内动脉狭窄支架植入术后支架内再狭窄的相关危险因素.方法 以intracranial artery,stent,restenosis,risk factors,predictors等英文词汇计算机检索1990年1月1日-2017年8月1日美国国立医学图书馆生物医学信息检索系统(PubMed)、荷兰医学文摘(EMBASE/SCOPUS)、Cochrane图书馆等数据库收录的关于颅内动脉狭窄支架植入术后支架内再狭窄相关危险因素的病例对照研究和队列研究.采用Newcastle-Ottawa量表(NOS)、RevMan 5.3统计软件进行文献质量评价和Meta分析.结果 共获得305篇文献,经剔除重复和不符合纳入标准者,最终纳入16项高质量(NOS评分≥6分)临床研究共计1102例患者(包括245例颅内动脉狭窄支架植入术后支架内再狭窄患者和857例颅内动脉狭窄支架植入术后无支架内再狭窄患者).Meta分析显示,糖尿病(OR=1.880,95％CI:1.290～2.740;P=0.001)、病变狭窄长度＞10 mm(OR=3.550,95％CI:1.160～ 10.850;P=0.030)、前循环病变(OR=1.680,95％CI:1.170～ 2.420;P =0.005)、术后残留狭窄率≥30％(OR=3.290,95％CI:1.460～7.410;P=0.004)和使用金属裸支架(OR=4.290,95％CI:1.130～16.260;P=0.030)是颅内动脉狭窄支架植入术后支架内再狭窄的危险因素.结论 糖尿病、病变狭窄长度＞ 10 mm、前循环病变、术后残留狭窄率≥30％和使用金属裸支架是颅内动脉狭窄支架植入术后支架内再狭窄的危险因素,临床医师应重视相关危险因素,进一步减少支架内再狭窄的发生.%Objective To assess the risk factors of in-stent restenosis (ISR) for intracranial artery stenosis by Meta-analysis.Methods Retrieve relevant case-control studies or cohort studies from online databases (January 1,1990-August 1,2017) as PubMed,EBMASE/SCOPUS and Cochrane Library with key words:intracranial artery,stent,restenosis,risk factors,predictors.Selection of studies was performed according to pre-designed inclusion and exclusion criteria.Quality of studies was evaluated by using Newcastle-Ottawa Scale (NOS).All data were pooled by RevMan 5.3 software for Meta-analysis.Results The research enrolled 305 articles,from which 16 high-quality (NOS score ≥ 6) studies were chosen after excluding duplicates and those not meeting the inclusion criteria.A total of 1102 cases (ISR:N =245;nonISR:N =857) were included.Meta-analysis showed that diabetes (OR =1.880,95％CI:1.290-2.740;P =0.001),lesions stenosis length ＞ 10 mm (OR =3.550,95％CI:1.160-10.850;P =0.030),anterior circulation lesions (OR =1.680,95％CI:1.170-2.420;P =0.005),postoperative residual stenosis ≥ 30％ (OR =3.290,95％CI:1.460-7.410;P=0.004) and bare metal stents (OR =4.290,95％CI:1.130-16.260;P=0.030)increased the risk of ISR significantly.Conclusions Diabetes,lesions stenosis length ＞ 10 mm,anterior circulation lesions,postoperative residual stenosis ≥ 30％ and bare metal stents were risk factors of in-stent restenosis.Clinicians should avoid related risk factors and reduce the occurrence of in-stent restenosis.