经导管肾交感神经消融术治疗慢性心力衰竭的有效性和安全性:Meta分析

Efficiency and safety of catheter-based renal denervation for chronic heart failure: Meta-analysis

目的通过Meta分析方法评价经导管肾交感消融术(RDN)治疗慢性心力衰竭的有效性及安全性。方法在Cochrane Library、PubMed、EMBASE、中国知网及万方数据库中,检索自建库至2018年12月发表的关于RDN治疗慢性心力衰竭的临床研究,经筛选后用于Meta分析。主要结局指标为左心室射血分数(LVEF)、左心室收缩末期内径(LVDD)及脑钠肽(BNP),次要结局指标为心率、收缩压及舒张压、6 min步行试验结果。采用Rev Man 5.3统计分析软件进行数据处理。以加权均数差(WMD)或标准化均数差(SMD)及95%CI表示效应量。随机对照试验(RCT)和队列研究(CS)采用"RDN组"和"药物治疗组"的结局指标变化,自身对照试验采用"治疗前"和"治疗后"的结局指标变化,进行Meta分析。结果共纳入8篇文献(230例患者)。在RCT/CS中,RDN组主要结局指标LVEF较药物治疗组明显升高[WMD=7.17,95%CI(3.77,10.56),P<0.01],LVDD[WMD=-4.42,95%CI(-0.59,0.26),P<0.01]及BNP[SMD=-1.48,95%CI(2.38,-1.12),P<0.01]明显降低;次要结局指标心率明显降低[WMD=-9.96,95%CI(-17.08,-2.12),P=0.01],收缩压明显升高[WMD=12.89,95%CI(1.15,24.17),P=0.27],舒张压及6 min步行试验结果差异均无统计学意义(P均>0.05)。自身对照试验中,RDN治疗后BNP较治疗前明显升高[SMD=-0.47,95%CI(-0.83,0.11),P=0.01],心率较治疗前明显降低[WMD=-2.57,95%CI(-4.75,-0.39),P=0.02],其余主要及次要结局指标差异均无统计学意义(P均>0.05)。结论经导管RDN治疗可明显改善慢性心力衰竭患者心功能。

Objective To evaluate the efficacy and safety of catheter-based renal denervation(RDN) for chronic heart failure using Meta-analysis. Methods Literature about catheter-based RDN for chronic heart failure were searched in Cochrane Library, PubMed, EMBASE, CNKI and Wanfang databases from the establishment of databases to Dec. 2018 for Meta-analysis after screening. The primary outcome indexes included left ventricular ejection fraction(LVEF), left ventricular end systolic diameter(LVDD) and brain natriuretic peptide(BNP), and the secondary outcome indexes included heart rate, systolic and diastolic blood pressures as well as the results of 6 min walk test. Data processing were performed using Rev Man 5. 3 software. The effect size was expressed as weighted mean difference(WMD) or standardized mean difference(SMD) and the 95% confidence interval(CI). For randomized controlled trials(RCT) and cohort studies(CS), the changes of outcomes were analyzed based on RDN group and drug-treated group, while for self-controlled trials were analyzed based on pre-treatment and post-treatment outcomes. Results A total of 8 studies involved 230 patients were finally included. In RCT/CS, LVEF of RDN group significantly increased than that of drug-treated group(weighted mean difference WMD=7.17, 95%CI [3.77, 10.56], P<0.01), while another primary outcome indexes including LVDD(WMD=-4.42, 95%CI [-0.59, 0.26], P<0.01) and BNP(SMD=-1.48, 95%CI [2.38,-1.12], P<0.01) significantly decreased. Compared with drug-treated group, the heart rate of RDN group significantly decreased(WMD=-9.96, 95%CI [-17.08,-2.12, P=0.01]), while the systolic blood pressure significantly increased(WMD=12.89, 95%CI [1.15, 24.17], P=0.27). And there was no statistic difference of diastolic blood pressure nor the results of 6 min walk test between RDN and drug-treated groups(all P>0.05). In self-controlled trials, BNP significantly increased(SMD=-0.47, 95%CI [-0.83, 0.11], P=0.01), while the heart rate significantly decreased(WMD=-2.57, 95%CI [-4.75,-0.39], P=0.02) after RDN. No statistic difference of another outcome indexes was found before and after RDN treatment(all P>0.05). Conclusion Catheter-based RDN can significantly improve cardiac function in patients with chronic heart failure.