药物涂层球囊治疗冠状动脉小血管原发病变疗效的meta分析

Efficacy of drug-coated balloon in the treatment of coronary small vessel disease:a meta-analysis

目的:通过meta分析评价药物涂层球囊(DCB)与普通球囊血管成形术(POBA)或药物洗脱支架(DES)对冠状动脉小血管原发病变(SVD)的治疗效果。方法:检索Cochrane Library、PubMed、Web of Science、Embase、CBM、中国知网、万方、维普数据库,检索时限为建库至2023年4月。采用RevMan 5.3和Stata 15.1软件进行meta分析和发表偏倚检验,根据不同的对照措施分亚组进行分析。结果:共纳入14篇RCT,包括3 354例患者。Meta分析显示,与POBA相比,DCB可降低SVD患者的靶病变血运重建(TLR)和再狭窄(BR)发生率,减少晚期管腔丢失(LLL)和管腔直径狭窄度(DS),增加最小管腔直径(MLD);但对主要不良心血管事件(MACE)和靶血管血运重建(TVR)发生率的影响,差异无统计学意义。与DES相比,DCB可降低SVD患者的MACE发生率,减少LLL和MLD,增加DS;但对TLR、TVR和BR发生率的影响,差异无统计学意义。结论:与POBA和DES相比,DCB可在一定程度上改善SVD患者的预后,减少LLL,但仍需纳入更多大样本、高质量的RCT来验证其对其他结局指标的影响。

Objective:To evaluate the therapeutic effects of the drug-coated balloon(DCB),plain balloon angioplasty(POBA) and drug-eluting stent(DES) on coronary small vessel disease(SVD) by meta-analysis.Methods:The Cochrane Library,PubMed,Web of Science,Embase,CBM,CNKI,Wanfang,and VIP databases were searched from inception to April 2023.Meta-analysis and publication bias test were performed by RevMan 5.3 and Stata 15.1 software,and subgroup analysis was performed according to different control measures.Results:A total of 14 RCTs involving 3 354 patients were included.Meta-analysis showed that compared with POBA,DCB reduced the incidence of target lesion revascularization(TLR) and restenosis(BR) in SVD patients,simultaneously reduced late lumen loss(LLL) and diameter stenosis(DS),and increased minimum lumen diameter(MLD),but there was no significant difference in the incidence of major adverse cardiovascular events(MACE) and target vessel revascularization(TVR).Compared with DES,DCB reduced MACE,LLL,MLD,and increased DS in patients with SVD,but there was no significant difference in TLR,TVR,and BR.Conclusion:Compared with POBA and DES,DCB can improve the prognosis of SVD patients to a certain extent and reduce the LLL,but more large-sample and high-quality RCTs are still needed to verify the clinical efficacy of other outcome indicators.