Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture.
Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture.
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DOI：
10.1161/jaha.117.007791
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发表时间：
2018-06-30
影响因子：
5.4
通讯作者：
Yeung KK
中科院分区：
文献类型：
--
作者：
Groeneveld ME;Meekel JP;Rubinstein SM;Merkestein LR;Tangelder GJ;Wisselink W;Truijers M;Yeung KK
腹主动脉瘤（AAA）的自然过程是生长和破裂，如果不及时治疗。许多标记已被调查，但没有一个被广泛承认。我们的目的是确定AAA生长和破裂的潜在预后标志物。潜在的循环，生物力学和遗传标记进行了研究。2017年2月，根据系统性综述和Meta‐分析（PRISMA）的首选报告项目指南，在PubMed、Embase和科克伦图书馆进行了全面检索。研究选择、数据提取和方法学质量评估由2名独立研究人员进行。标记物的合理性基于关于标记物的出版物数量（超过3）、合并样本量（超过100）、偏倚风险和研究的统计学显著性。纳入了82项研究，检查了循环（n=40）、生物力学（n=27）和遗传标记物（n=7）以及标记物组合（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）、肺炎衣原体（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Meta分析。我们确定了5个对AAA生长有预后价值的潜在标志物和2个对破裂有预后价值的标志物。在解释这些数据时，必须认识到结论是基于小样本量和临床和方法学异质性。因此，迫切需要对这些潜在的辅音标记进行前瞻性和方法学的研究。
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.