摘要：

目的 系统评价椎动脉起始部支架植入术后支架内再狭窄的危险因素，以为临床预防和治疗椎动脉起始部支架植入术后支架内再狭窄提供理论指导。方法 以vertebral artery、vertebrobasilar insufficiency、stents、drug-eluting stents、self expandable metallic stents，以及椎动脉、椎底动脉供血不足、支架、再狭窄、危险因素等中英文词汇，计算机检索1966 年1 月1 日-2017 年3 月30 日美国国立医学图书馆生物医学信息检索系统（PubMed）、荷兰医学文摘（EMBASE/SCOPUS）、Cochrane 图书馆，以及中国生物医学文献数据库、中国知网中国知识基础设施工程、万方数据库、维普数据库等发表的关于椎动脉起始部支架植入术后支架内再狭窄相关危险因素的病例对照研究和队列研究。采用Newcastle-Ottawa 量表和Stata 12.0 统计软件进行文献质量评价和Meta 分析。结果 共获得3468 篇中英文文献，经剔除重复和不符合纳入标准文献，最终纳入11 项临床研究共440 例椎动脉起始部支架植入术后支架内再狭窄患者和912 例椎动脉起始部支架植入术后无支架内再狭窄患者。Meta 分析显示，再狭窄组与无再狭窄组患者吸烟史（OR = 2.179，95%CI：1.373 ~ 3.458；P = 0.001）、金属裸支架（OR = 2.072，95%CI：1.560 ~ 2.753；P = 0.000）和药物洗脱支架（OR = 0.483，95%CI：0.363 ~ 0.641；P = 0.000）使用率差异有统计学意义。结论 吸烟史和使用金属裸支架是椎动脉起始部支架植入术后支架内再狭窄的危险因素，使用药物洗脱支架是保护因素。由于受到所纳入研究的限制，上述结论可能存在偏倚，尚待开展更多研究验证上述危险因素与椎动脉起始部支架植入术后支架内再狭窄的关联性。

关键词: 椎底动脉供血不足, 支架, 危险因素, Meta分析

Abstract:

Objective  To systematically review the risk factors for in-stent restenosis (ISR) of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment.  Methods  Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS) and Stata 12.0 software.  Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440) and non-ISR group (N = 912). The ISR incidence rate of smokers was significantly higher than non-smokers (OR = 2.179, 95%CI: 1.373-3.458; P = 0.001). The differences of bare metal stents (BMS) utilization rate (OR = 2.072, 95% CI: 1.560-2.753; P = 0.000) and drug-eluting stents (DES) utilization rate (OR = 0.483, 95% CI: 0.363-0.641; P = 0.000) between ISR group and non-ISR group were statistically significant.  Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion.

Key words: Vertebrobasilar insufficiency, Stents, Risk factors, Meta-analysis