三位点起搏与传统心脏再同步化治疗慢性心力衰竭有效性和安全性的Meta分析

Meta-analysis of effectiveness and safety of three-site pacing and traditional cardiac resynchronization in the treatment of chronic heart failure

目的 系统评价三位点起搏与传统心脏再同步化治疗慢性心力衰竭的疗效和安全性.方法 计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、WanFang Data和CBM数据库,并手工检索相关会议论文集,以补充获取相关文献,搜集三位点起搏与传统心脏再同步化治疗慢性心力衰竭的研究文献,检索时限均从建库至2018年5月31日.由两位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.2软件进行Meta分析.结果 共纳入5项研究,共计197例慢性心力衰竭患者.Meta分析结果显示:与传统心脏再同步化治疗相比,三位点起搏治疗可以提高左心室射血分数(MD=5.84,95%CI:2.43~9.24,P=0.0008),改善左室收缩末容积(MD=-24.67,95%CI:-45.19^-4.16,P=0.02);而两者在左室舒张末容积(MD=-14.06,95%CI:-38.83~10.71,P=0.27)、QRS波时限(MD=-12.70,95%CI:-39.10~13.70,P=0.35)、6分钟步行试验(MD=14.16,95%CI:-25.90~54.23,P=0.49)、明尼苏答生活质量评分(MD=-4.95,95%CI:-11.96~2.05,P=0.17)、最大摄氧量(MD=0.65,95%CI:-0.58~1.88,P=0.30)、心室内延迟时间(MD=-3.02,95%CI:-9.44~3.40,P=0.36)、术中透视时间(MD=2.18,95%CI:-2.39~6.74,P=0.35)和手术时间(MD=31.78,95%CI:-21.37~84.92,P=0.24)等方面,均无统计学差异.结论 三位点起搏治疗可以提高慢性心力衰竭患者心功能,缩小左室收缩末容积.但受纳入研究数量和质量的限制,本研究结论尚需开展更多高质量研究予以证实.

Objective To systematically evaluate the efficacy and safety of triple-site ventricular pacing(Tri-V)versus conventional cardiac resynchronization therapy in the treatment of chronic heart failure.Methods We searched PubMed,EMbase,Web of Science,The Cochrane Library,China National Knowledge Internet,WanFang Data,VIP and chinese biomedical medicine databases to collect clinical studies about Triple-site ventricular pacing versus cardiac resynchronization therapy for patients with chronic heart failure from inception to 31 May 2018.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was performed by Revman 5.2 software.Results Five studies were included in a total of 197 patients with chronic heart failure.Meta analysis results show that compared with traditional cardiac resynchronization therapy,three-site pacing therapy can increase left ventricular ejection fraction(MD=5.84,95%CI:2.43~9.24,P=0.0008)and improve left ventricular systole End volume(MD=-24.67,95%CI:-45.19^-4.16,P=0.02);and both in the left ventricle end diastolic volume(MD=-14.06,95%CI:-38.83~10.71,P=0.27),QRS wave time limit(MD=-12.70,95%CI:-39.10~13.70,P=0.35),six-minute walking test(MD=14.16,95%CI:-25.90~54.23,P=0.49),Minney Suda quality of life score(MD=-4.95,95%CI:-11.96~2.05,P=0.17),maximum oxygen uptake(MD=0.65,95%CI:-0.58~1.88,P=0.30),intraventricular Delay time(MD=-3.02,95%CI:-9.44~3.40,P=0.36),intraoperative fluoroscopy time(MD=2.18,95%CI:-2.39~6.74,P=0.35),and operation time(MD=31.78,95%CI:-21.37~84.92,P=0.24),there was no statistical difference.Conclusion Three-site pacing therapy can improve cardiac function and reduce left ventricular end-systolic volume in patients with chronic heart failure.However,limited by the number and quality of included studies,the conclusions of this study need to be confirmed by more high-quality studies.