SYNTAX系列评分在复杂冠状动脉病变中的应用进展

摘要：目的：比较沙库巴曲缬沙坦(LCZ696)与血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)或血管紧张素受体阻滞剂(angiotensin receptor blocker,ARB)治疗难治性心力衰竭(refractory heart failure,RHF)患者的疗效和安全性，为临床提供参考依据。方法：通过检索pubmed，embase，web of science，cochrane，CBM，知网等数据库中已发表的中文和英文的随机对照研究(randomized controlled trials,RCTs)。筛选文献，提取数据后，采用cochrane偏倚风险评估工具对纳入的RCTs质量进行评价，采用Stata15.1和Revman 5.4进行meta分析。结果：共纳入13篇文献，总计1338例患者。meta分析结果显示：研究组N端B型利钠肽（N-terminal pro-B-type natriuretic,NT-proBNP）WMD=-294.79，95%CI(-422.28，-167.31)，P=0.000]、高敏感性心肌肌钙蛋白T（high-sensitivity cardiac troponin T,hs-cTnT）WMD=-0.09，95%CI(-0.11，-0.08)，P=0.000]、左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD) WMD=-4.00，95%CI(-5.34，-2.67)，P=0.000]、左室收缩末期内径(left ventricular end-systolic diameter,LVESD) WMD=-4.94，95%CI(-7.05，-2.82)，P=0.000]低于对照组；左室射血分数(left ventricular ejection fraction,LVEF) WMD=5.88，95%CI(4.38，7.38)，P=0.000]、6分钟步行距离(6-min walking distance ,6MWD)、有效率RR=1.81，95%CI(1.11，1.26)，P=0.000]明显高于对照组；两组细胞间黏附分子(intercellular cell adhesion molecule,ICAM-1) WMD=-3.37，95%CI(-9.08，2.35)，P=0.248]、血肌酐(creatinine,CREA) WMD=0.61，95%CI(-1.18，2.41)，P=0.505]、醛固酮(aldosterone,ALD) WMD=-12.27，95%CI(-30.39，5.85)，P=0.184]水平差异无统计学意义。研究组低血压RR=0.56，95%CI(0.19，1.63)，P=0.284]、头晕RR=1.00，95%CI(0.26，3.92)，P=1.000]、恶心/呕吐RR=1.67，95%CI(0.22，12.35)，P=0.617]、粒细胞减少RR=1.00，95%CI(0.14，6.93)，P=1.000]、高钙血症RR=3.00，95%CI(0.32，28.25)，P=0.337]与对照组相比较差异无统计学意义。结论：LCZ696疗效好，能显著提高RHF患者心功能，改善心室重塑，减轻心肌组织损伤，无明显不良反应。

Application progress of the SYNTAX score and its derivative score in complex coronary artery disease

Insulin resistance has significant effect in the artery plaque formation and progress, plays an important role in the pathogenesis of cardiovascular disease (CVD). Triglyceride?glucose index has been confirmed as reliable alternative indicators of insulin resistance and closely correlate with the development and prognosis of acute coronary artery syndrome, this review aim to investigate the relationship of triglyceride?glucose index and acute coronary syndrome.