多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

Effectiveness and safety of multipoint pacing and conventional cardiac resynchronization therapy for chronic heart failure:a Meta-analysis

目的系统评价多位点起搏(MPP)与传统心脏再同步化治疗(CRT)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,搜集多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6月1日。由2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 5.3软件进行Meta分析。结果共纳入13项研究,包括1195例慢性心力衰竭患者。Meta分析结果显示,与传统CRT组相比,MPP组QRS波时限缩短(MD=-5.72,95%CI:-10.11^-1.33,P=0.01),左心室射血分数增加(MD=4.55,95%CI:3.72~5.38,P<0.00001),CRT应答率提高(OR=3.92,95%CI:2.16~7.12,P<0.00001)。而两者在左心室内压最大上升速率方面(MD=53.12,95%CI:-21.14~127.39,P=0.16),差异无统计学意义。结论MPP在治疗慢性心力衰竭的安全性和有效性方面优于传统CRT治疗。现有证据表明,多位点起搏治疗技术在临床治疗慢性心力衰竭方面有广阔的应用前景。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 review systematically the curative effect and safety of multipoint pacing(MPP)and conventional cardiac resynchronization therapy(CRT)for chronic heart failure(CHF).Methods The databases of PubMed,EMbase,Web of Science,Cochrane Library,CNKI,WanFang Data and CBM were retrieved with computer,and relative conference proceedings were manually searched to collect the research literature of MPP and CRT for treating CHF.The time limit was from database establishment time to June 1,2018.The literature was screened,data was extracted and risk of bias in included literature was independently reviewed by 2 researchers.A Meta-analysis was conducted by applying RevMan 5.3 software.Results There were totally 13 studies included involved 1195 patients with CHF.The results of Meta-analysis showed that QRS duration was shortened(MD=-5.72,95%CI:-10.11^-1.33,P=0.01)and LVEF increased(MD=4.55,95%CI:3.72~5.38,P<0.00001)in MPP group compared with CRT group.The response rate of CRT was increased(OR=3.92,95%CI:2.16~7.12,P<0.00001).The difference in maximal ascending velocity of left ventricle pressure had no statistical significance between 2 groups(MD=53.12,95%CI:-21.14~127.39,P=0.16).Conclusion MPP is superior to CRT in safety and effectiveness for CHF.The available evidence shows that MPP therapy has broad application prospects in clinical treatment of CHF.The conclusion still needs to be verified by more high-quality studies due to the limited quantity and quality of included studies.