经皮经腔间隔心肌消融术与室间隔部分切除术治疗梗阻性肥厚型心肌病的Meta分析

Comparison of the effects of ablation or surgery treatment for obstructive hypertrophic cardiomyopathy——a Meta analysis

目的:对比评价经皮经腔间隔心肌消融术(消融)与室间隔部分切除术(手术)治疗梗阻性肥厚型心 肌病(OHCM)的疗效。方法:检索Pubmed,找到3篇对比消融与手术治疗OHCM的文章进行Meta分析。结 果:共计177例患者,86例消融,91例手术。消融使平均室间隔厚度由22.1mm降至15.1mm(P<0.05),手术 使平均室间隔厚度由22.0mm降至13.9mm(P<0.05),两种治疗方法相比较差异无统计学意义(P>0.05); 消融使平均左室流出道(LVOT)压差由10.1kPa降至2.1kPa(P<0.05),手术使平均LVOT压差由9.9kPa降 至1.3kPa(P<0.05),手术优于消融(P<0.05);消融使平均左室舒张末期内径由41.8mm增至45.2mm(P <0.05),手术使平均左室舒张末期内径由41.8mm增至43.9mm(P<0.05),消融与手术相比较差异无统计学 意义(P>0.05);消融使平均NYHA分级由3.17升至1.47(P<0.05),手术使平均HYNA分级由2.97升至 1.36(P<0.05),消融与手术相比较差异无统计学意义(P>0.05)。结论:消融与手术治疗OHCM的客观指标 与主观指标均较为接近,进行消融与手术治疗大规模随机对照试验应是切实可行的也是必要的。

Objective:To compare the effects of percutaneous transluminal septal myocardial ablation ( PTSMA ) with septal myectomy in patients with obstructive hypertrophic cardiomyopathy ( OHCM). Method:Three articles comparing the effects of ablation and surgery treatment for OHCM were identified from search in Pubmed, then a Meta analysis was conducted. Result:One hundred and seventy-seven patients (86 underwent PTSMA and 91 underwent septal myectomy ) were included. Interventricular septum thickness was decreased from 22.1 mm to 15.1 mm (P< 0.05 ) in PTSMA group and from 22.0 mm to 13.9 mm (P< 0.05) in septal myectomy group; left ventricular end-diastolic dimension was increased from 41.8 mm to 45.2 mm (P< 0.05) in PTSMA group and from 41.8 mm to 43.9 mm (P< 0.05) in setpal myectomy group; NYHA class was improved from 3.17 to 1.47 ( P< 0.05 ) in PTSMA group and from 2.97 to 1.36 ( P< 0.05 ) in septal myectomy group; there were no differences in the two groups. However, left ventricular outflow tract gradient was decreased from 10.1 kPa to 2.1 kPa ( P< 0.05 ) in PTSMA group and from 9.9 kPa to 1.3 kPa ( P< 0.05 ) in septal myectomy group and the effect of septal myectomy was better than PTSMA ( P< 0.05 ).Conclusion:The effects of PTSMA for OHCM appear similar to septal myectomy. Large randomized clinical trials further comparing the two treatments are suggested.