冠状动脉钙化积分与冠状动脉疾病及全因性死亡相关性的Meta分析

doi:10.3969/j.issn.1004-583X.2021.04.001

摘要/Abstract

摘要：

目的系统评价冠状动脉钙化积分(CACS)与冠状动脉疾病(CAD)及全因死亡事件相关性。方法计算机检索Pubmed、The Cochrane Library、EMbase、CKNI、WanFang Data数据库,搜集CACS与CAD及全因性死亡(All-cause mortality)相关性的队列研究,检索时限从建库至2020年6月。由2名资料员提取文献并进行评价纳入研究的偏倚风险后,采用 Stata 14.0软件进行Meta分析。结果纳入11个队列研究,包括59 143例被研究者。Meta结果显示:与CACS<10相比,CACS≤100组[HR=2.46,95%CI(1.77,3.41),P=0.000,I²=55.5%]、100<CACS≤400组[HR=3.62,95%CI(2.24,5.83),P=0.000,I²=42.2%]、CACS>400组[HR=5.09,95%CI(2.02,12.84),P=0.001,I²=70.7%]更易发生CAD及全因死亡事件。结论对于存在CAC的患者来说,有更高的患有CAD及全因死亡事件风险。

关键词: 冠状动脉疾病, 冠状动脉钙化积分, 全因死亡事件, Meta分析

Abstract:

Objective To systematically review the correlations among coronary artery calcification score(CACS), coronary artery disease and all-cause mortality. Methods The databases of Pubmed, The Cochrane Library, EMbase, CKNI and WanFang Data were electronically searched to collect cohort studies on the correlations between CACS, CAD and all-cause mortality from the inception of databases to June 2020. Meta analysis was performed with Stata 14.0 software when two data clerks independently screened literatures, they extracted data and assessed risk of bias of included studies. Results A total of 11 cohort studies were included, including 59 143 cases. The Meta results showed that CACS≤100 group [HR=2.46,95%CI(1.77,3.41),P=0.000,I²=55.5%],100<CACS≤400 group[HR=3.62,95%CI(2.24,5.83),P=0.000,I²=42.2%] and CACS>400 group [HR=5.09,95%CI(2.02,12.84),P=0.001,I²=70.7%] are more likely to occur CAD and all-cause deaths compared to CACS<10 group. Conclusion There is a higher risk of coronary artery disease and all-cause mortality for patients with CAC.

Key words: coronary artery disease, coronary artery calcification score(CACS), all-cause mortality, meta analysis

中图分类号:

R541.4

毕月, 李拥军, 王萌萌. 冠状动脉钙化积分与冠状动脉疾病及全因性死亡相关性的Meta分析[J]. 临床荟萃, 2021, 36(4): 293-302.

Bi Yue, Li Yongjun, Wang Mengmeng. Meta analysis of correlation between coronary artery calcification score and coronary artery disease and all-cause mortality[J]. Clinical Focus, 2021, 36(4): 293-302.

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https://lchc.magtechjournal.com/CN/Y2021/V36/I4/293

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参考文献 36

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纳入研究	年限	试验类型	国家	样本量 (人)	平均年龄 (岁)	原始研究纳入标准及CACS分组	研究结局	平均随访时间(年)
Elkeles	2008	前瞻性研究	英国	589	63.1	无症状人群的T2DM,11~100,101~400,401~1000,1001~10000	心血管事件	4.0
Carr	2017	前瞻性研究	美国	5115	40.3±3.6	无症状人群,1~ 1 9,20~100,和>100	冠心病、心血管疾病、全因死亡率	12.5
Chaikrian	2015	回顾性研究	美国	805	58.0±13.0	有胸痛症状人群,1~100, 101~400,>400	心脏不良事件	2.3±0.9
Chen	2017	前瞻性研究	美国	1541	21~74	慢性肾衰竭患者,1~100,>100	心血管疾病、心肌梗死、心力衰竭和全因死亡率	5.9
Paixao	2015	前瞻性研究	美国	2084	44.4±9.0	无症状患者,1~10, 10~100,>100	冠心病事件	9.2±1.3
Greenland	2004	前瞻性研究	美国	1029	65.7±7.8	无症状人群1~100, 101~300,>300	非致命性心肌梗死或冠心病死亡	7.0
Budoff	2007	前瞻性研究	美国	25253	56.0±11.0	无症状患者,1~10,11~100,101~399,400~699, 700~999,>1000	全因死亡率	6.8±3.0
Detrano	2008	前瞻性研究	美国	6722	62.2±10.2	无症状人群,1~100,101~300,>300	冠状动脉事件	3.8
Nakanishi	2015	回顾性研究	美国	5584	56.6±11.6	无症状人群,1~99,100~399, ≥400	全因死亡率	10.4±3.1
Budoff	2017	前瞻性研究	美国	4209	60.6±8.2	有胸痛症状人群,1~ 100, 101~400,和>400	心血管不良事件	2.2
Budoff	2019	前瞻性研究	美国	1205	42.8 ±6.8	无症状人群伴有1型糖尿病, 1~100,101~300,和>300	心血管不良事件	7~9

纳入研究	年限	试验类型	国家	样本量 (人)	平均年龄 (岁)	原始研究纳入标准及CACS分组	研究结局	平均随访时间(年)
Elkeles	2008	前瞻性研究	英国	589	63.1	无症状人群的T2DM,11~100,101~400,401~1000,1001~10000	心血管事件	4.0
Carr	2017	前瞻性研究	美国	5115	40.3±3.6	无症状人群,1~ 1 9,20~100,和>100	冠心病、心血管疾病、全因死亡率	12.5
Chaikrian	2015	回顾性研究	美国	805	58.0±13.0	有胸痛症状人群,1~100, 101~400,>400	心脏不良事件	2.3±0.9
Chen	2017	前瞻性研究	美国	1541	21~74	慢性肾衰竭患者,1~100,>100	心血管疾病、心肌梗死、心力衰竭和全因死亡率	5.9
Paixao	2015	前瞻性研究	美国	2084	44.4±9.0	无症状患者,1~10, 10~100,>100	冠心病事件	9.2±1.3
Greenland	2004	前瞻性研究	美国	1029	65.7±7.8	无症状人群1~100, 101~300,>300	非致命性心肌梗死或冠心病死亡	7.0
Budoff	2007	前瞻性研究	美国	25253	56.0±11.0	无症状患者,1~10,11~100,101~399,400~699, 700~999,>1000	全因死亡率	6.8±3.0
Detrano	2008	前瞻性研究	美国	6722	62.2±10.2	无症状人群,1~100,101~300,>300	冠状动脉事件	3.8
Nakanishi	2015	回顾性研究	美国	5584	56.6±11.6	无症状人群,1~99,100~399, ≥400	全因死亡率	10.4±3.1
Budoff	2017	前瞻性研究	美国	4209	60.6±8.2	有胸痛症状人群,1~ 100, 101~400,和>400	心血管不良事件	2.2
Budoff	2019	前瞻性研究	美国	1205	42.8 ±6.8	无症状人群伴有1型糖尿病, 1~100,101~300,和>300	心血管不良事件	7~9