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目的评价系统性硬化症患者是否更易存在左心舒张功能不全。方法计算机检索The Cochrane Library、PubMed、EMbase、CBM、CNKI和WanFang Data数据库,搜集比较系统性硬化症患者与对照组心脏超声指标的研究,检索时限均为1990年1月至2016年6月。由2位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入22个研究,包括1 146例患者。Meta分析结果显示:和对照组相比,系统性硬化患者左心室等容舒张时间较长[MD=10.40,95%CI(4.04,16.77),P=0.001],经二尖瓣晚期充盈的充盈峰值较高[MD=0.11,95%CI(0.07,0.15),P<0.000 01],二尖瓣减速时间较长[MD=8.04,95%CI(2.66,13.42),P=0.003],左心房直径较大[MD=1.43,95%CI(0.11,2.76),P=0.03],肺动脉压估计值较高[MD=11.35,95%CI(6.08,16.6),P<0.001],二尖瓣早期快速充盈的充盈峰值较低[MD=–0.03,95%CI(–0.05,–0.01),P=0.000 3],E/A比值较低[MD=–0.24,95%CI(–0.32,–0.15),P<0.000 01],E’较低[MD=–1.52,95%CI(–2.44,–0.60),P=0.001]以及E/E’值较高[MD=2.08,95%CI(0.19,3.96),P=0.03]。但在左心室射血分数、左心室收缩末直径、室间隔舒张末厚度和后壁舒张末厚度方面,两组差异均无统计学意义。结论系统性硬化症患者更易出现左心功能不全。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To evaluate whether left-ventricular diastolic dysfunction is more likely to occur in patients with systemic sclerosis. Methods The Cochrane Library, PubMed, EMbase, CBM, CNKI and WanFang Data databases were searched by computer to compare the echocardiographic indexes of patients with systemic sclerosis and control group. The retrieval time ranged from January 1990 to June 2016. After the two reviewers independently screened the literature, extracted data, and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results Twenty-two studies were included, including 1,146 patients. Meta-analysis showed that compared with the control group, left ventricular isovolumic relaxation time was longer in patients with systemic sclerosis (MD = 10.40, 95% CI 4.04, 16. 77, P 0.001) (MD = 0.11, 95% CI (0.07, 0.15), P <0.000 01] and mitral valve deceleration time longer (MD = 8.04,95% CI 2.66,13.42, P = 0.003) The atrial diameter was larger (MD = 1.43, 95% CI 0.11, 2.76, P = 0.03) and the estimated pulmonary arterial pressure was higher (MD = 11.35, 95% CI 6.08, 16.6, P 0.001) The fast filling early filling rate was lower (MD = -0.03, 95% CI (-0.05, -0.01), P = 0.0003], with a lower E / A ratio [MD = -0.24,95% CI , -0.15), P <0.000 01], lower E ’[MD = -1.52,95% CI (-2.44, -0.60), P = 0.001] and higher E / E’ values [MD = 2.08, 95 % CI (0.19, 3.96), P = 0.03]. However, in left ventricular ejection fraction, left ventricular end-systolic diameter, end-diastolic end-diastolic thickness and posterior wall end-diastolic thickness, there was no significant difference between the two groups. Conclusion Patients with systemic sclerosis are more likely to have left ventricular dysfunction. Due to the limited number and quality of studies included, the above conclusions have yet to be validated by more high-quality studies.