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目的评价冠心病合并糖尿病多支血管病变介入治疗与外科旁路移植术治疗效果。方法计算机检索Cochrane图书馆、Med Line、EMbase(1974-2014.11)、中国生物医学文献数据库、中国期刊全文数据库和万方数据库,收集冠心病合并糖尿病多支血管病变介入治疗与外科旁路移植术治疗的随机对照研究(RCT)。有两名评价员按照纳入与排除标准选择文献,评价质量与提取资料,对符合纳入标准的研究以Rev Man5.2软件进行Meta分析。结果共纳入5个随机对照研究,共2288例患者。Meta分析结果显示,介入治疗与外科旁路移植比较,随访30 d患者全因病死率与MACE事件发生率差异无统计学意义,RR=0.42,95%CI(0.05~3.44),P=0.42。对随访1年以上的长期随访结果分析:全因病死率差异无统计学意义,RR=0.14,95%CI(0.47~2.78),P=0.77。MACE事件发生率,两组差异有统计学意义RR=1.65,95%CI(1.29~2.11),P<0.0001。说明从远期MACE事件发生率而言外科旁路移植术对于治疗冠心病合并糖尿病伴多支血管病变患者更占优势。对于长期靶血管重建率Meta分析结果显示两组差异有统计学意义RR=3.08,95%CI(2.28~4.17),P<0.00001。此结果说明外科旁路移植术更优于介入治疗,靶血管重建较介入治疗低。CCSII级人数Meta分析结果显示,两组差异有统计学意义,RR=2.07,95%CI(1.50~2.87),P<0.0001。外科旁路移植术随访1年后远期轻度心绞痛情况更少见。结论冠心病伴糖尿病多支血管病变患者治疗上对于MACE事件发生率,长期靶血管重建,CCSII级事件发生的情况看,外科旁路移植术疗效更优于介入治疗术。
Objective To evaluate the therapeutic effect of interventional therapy and surgical bypass grafting in patients with coronary artery disease and coronary artery disease. Methods The Cochrane Library, Med Line, EMbase (1974-2014.11), Chinese Biomedical Literature Database, Chinese Journal Full-text Database and Wanfang Database were collected. The interventional treatment of coronary artery disease complicated with multivessel disease and surgical bypass grafting were collected. Randomized controlled study (RCT). Two reviewers selected the literature based on inclusion and exclusion criteria, evaluated the quality and extracted the data, and met the inclusion criteria for the meta-analysis using Rev Man 5.2 software. Results A total of 5 RCTs were enrolled, with a total of 2288 patients. Meta-analysis showed that there was no significant difference between interventional treatment and surgical bypass grafting in all-cause mortality and MACE events at follow-up of 30 days (RR = 0.42, 95% CI: 0.05-3.44, P = 0.42). Long-term follow-up of more than 1 year follow-up analysis of the results: all-cause mortality was no significant difference, RR = 0.14,95% CI (0.47 ~ 2.78), P = 0.77. The incidence of MACE was statistically significant between the two groups (RR = 1.65, 95% CI 1.29-2.11), P <0.0001. This suggests that surgical bypass grafting is more preponderant in treating patients with coronary heart disease complicated with diabetes and multivessel disease from the incidence of long-term MACE events. For the long-term target vessel reconstruction rate Meta analysis showed that the difference between the two groups was statistically significant RR = 3.08,95% CI (2.28 ~ 4.17), P <0.00001. This result shows that surgical bypass grafting is better than interventional therapy and target vascular reconstruction is lower than interventional therapy. Meta analysis showed that the difference between the two groups was statistically significant, RR = 2.07, 95% CI (1.50-2.87), P <0.0001. Postoperative surgical bypass grafting 1 year after the long-term mild angina more rare. Conclusion The treatment of patients with coronary heart disease complicated with diabetic multivessel disease is more effective than interventional therapy in the treatment of MACE event, long-term target vessel revascularization and occurrence of CCSII-class events.