如果不治疗,腹主动脉瘤(AAA)的自然过程是生长和破裂。已经研究了许多标记;然而,没有一个得到广泛承认。我们的目的是确定AAA生长和破裂的潜在预后标志物。
潜在循环,生物力学,并对遗传标记进行了研究。在PubMed进行了全面搜索,Embase,和Cochrane图书馆于2017年2月,遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目。研究选择,数据提取,方法学质量评价由2名独立研究者进行.标记的合理性是基于关于标记的出版物的数量(超过3),合并样本量(超过100),研究的偏倚风险和统计意义。包括82项研究,检查循环(n=40),生物力学(n=27),和遗传标记(n=7)和标记的组合(n=8)。扩张风险增加的因素包括:AAA直径(9项研究;n=1938;低偏倚风险),衣原体肺炎(4项研究;n=311;中等偏倚风险),S-弹性蛋白肽(3项研究;n=205;中等偏倚风险),氟脱氧葡萄糖摄取(3项研究;n=104;中等偏倚风险),和腔内血栓大小(5项研究;n=758;中等偏倚风险)。破裂风险增加的因素包括:峰值壁应力(9项研究;n=579;中等偏倚风险)和AAA直径(8项研究;n=354;中等偏倚风险)。由于临床和方法学异质性,未进行荟萃分析。
我们确定了5个对AAA生长具有预后价值的潜在标志物和2个对破裂具有预后价值的标志物。在解释这些数据时,我们必须认识到,结论是基于小样本量和临床和方法学异质性。强烈敦促前瞻性和方法学辅音研究进一步研究这些潜在的标志物。
The natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture.
Potential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty-two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S-elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta-analysis was conducted because of clinical and methodological heterogeneity.
We identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.