肾动脉交感神经消融术治疗顽固性高血压有效性的Meta分析

Effectiveness of renal denervation therapy for resistant hypertension: a meta-analysis

目的系统评价肾动脉交感神经消融术治疗顽固性高血压的有效性和安全性。方法计算机检索Pub Med、EMBASE、MEDLINE、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI),纳入肾动脉交感神经消融术与药物治疗顽固性高血压有效性及安全性的随机对照研究和队列研究。由两名评价员按照纳入与排除标准筛选文献,提取资料和评价质量后,采用Cochrane协作网提供的Rev Man 5.3统计软件进行Meta分析。结果共纳入7篇文献,包括3篇随机对照研究(共668例患者),4篇队列研究(共259例患者)。随机对照研究Meta分析结果显示:术后6个月肾动脉交感神经消融术组(RDN组)与对照组收缩压下降差异无统计学意义(WMD-18.85 mm Hg,95%CI-37.89~0.19,P=0.05)(1 mm Hg=0.133 k Pa),但RDN组舒张压下降显著高于对照组(WMD-7.08 mm Hg,95%CI-13.25^-0.90,P=0.02)。队列研究Meta分析结果显示:术后6个月RDN组收缩压和舒张压下降显著高于对照组(WMD-25.14 mm Hg,95%CI-30.50^-19.77,P<0.00001;WMD-6.13 mm Hg,95%CI-6.85^-5.42,P<0.00001)。手术并发症包括2例死亡、2例股动脉假性动脉瘤、1例肾动脉夹层。结论肾动脉交感神经消融术可显著降低顽固性高血压患者舒张压,但对降低收缩压疗效不明确。肾动脉交感神经消融术不良事件发生率较低,具有良好的安全性。高质量大规模多中心研究及术后长期随访是未来研究的重点。

Objective To assess the effectiveness and safety of renal denervation and medication therapy for resistant hypertension. Methods Databases including Pub Med,EMbase,MEDLINE,the Cochrane Library,CMB and CNKI were searched to collect the randomized controlled trials（ RCTs） and cohort study trials（ CSTs） about the effectiveness and safety of renal denervation and medication therapy for resistant hypertension. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently. The quality was evaluated. The data were extracted and meta-analyses were performed by using Rev Man 5. 3 software. Results Seven trials were included,of which 3 were RCTs involving 668 patients,and 4 were cohort study trials involving 259 patients. Among the RCTs,there was a reduction in mean systolic and diastolic blood pressure（ BP） at 6 months of（ WMD- 18. 85 mm Hg,95%CI- 37. 89-0. 19,P = 0. 05） and（ WMD- 7. 08 mm Hg,95% CI- 13. 25-- 0. 90, P = 0. 02）respectively,compared with the control. Among the CSTs,there was a reduction in mean systolic and diastolic blood pressure（ BP） at 6 months of（ WMD- 25. 14 mm Hg,95% CI- 30. 50-- 19. 77,P 〈0. 00001） and（ WMD- 6. 13 mm Hg,95% CI- 6. 85-- 5. 42,P 〈 0. 00001） respectively,compared with the control. Reported procedural complications included 2 death,one renal artery dissection and 2 femoral pseudo aneurysms. Conclusions The therapy of RDN can significantly reduce the diastolic blood pressure in patients with resistant hypertension,but the lowering systolic blood pressure effect is not obvious. With few adverse events reported,RDN has favorable safety. High quality large multicenter studies and long-term follow-up after surgery is the focus of future research.