去肾神经术联合肺静脉隔离术治疗高血压合并房颤的有效性和安全性荟萃分析

Efficacy and safety of renal denervation combined with pulmonary vein isolation in patients with hypertension and atrial fibrillation:a meta-analysis

目的通过荟萃分析评价去肾神经术(RDN)和肺静脉隔离术(PVI)治疗高血压合并房颤的有效性和安全性。方法检索PubMed、The Cochrane Library、EMbase、Web of Science、中国生物医学文献数据库、万方数据库、中国知网(CNKI)等数据库中2010年1月至2023年4月发表的RDN联合PVI治疗高血压合并房颤的临床研究文献。用RevMan5.3软件进行荟萃分析,使用Stata15.1软件进行敏感性分析和发表偏倚分析。结果最终纳入10项文献,共859例患者。分析结果显示,与PVI组相比,RDN联合PVI组术后1年房颤复发率减低(RR=0.61,95%CI 0.51~0.72,P<0.01),术后2年房颤复发率差异无统计学意义。与PVI组相比,阵发性房颤患者、难治性高血压患者RDN联合PVI组术后1年房颤复发率减低(RR=0.64,95%CI 0.51~0.81;RR=0.66,95%CI 0.52~0.83)。与PVI组相比,RDN联合PVI组术后1年诊室收缩压和舒张压降低[加权均数差(WMD)(95%CI)分别为-11.58(-18.14~-5.02)mmHg、-5.90(-8.72~-3.07)mmHg],术后半年到1年肾小球滤过率升高[WMD(95%CI)为14.79(12.95~16.63)mL/(min·1.73m2)]、血肌酐和尿白蛋白/尿肌酐下降[WMD(95%CI)分别为-0.27(-0.36~-0.18)mg/dL、-50.26(-77.01~-23.52)mg/g],术后半年到1年室间隔厚度、左心室舒张末期内径和左心室质量指数降低[WMD(95%CI)分别为-1.25(-1.57~-0.93)mm、-2.37(-4.63~-0.11)mm、-14.59(-18.06~-11.11)g/m2(均P<0.01)]。安全性方面,两组并发症发生率差异无统计学意义(RR=1.42,95%CI 0.74~2.75,P=0.29)。结论RDN联合PVI可降低高血压合并房颤患者术后1年房颤复发率,但不能改善术后2年房颤复发率,联合手术有效性和安全性较好。

Objective To evaluate the effectiveness and safety of renal denervation(RDN)and pulmonary vein isolation(PVI)for the treatment of hypertension combined with atrial fibrillation by a meta-analysis.Methods PubMed,The Cochrane Library,EMbase,Web of Science,China Biomedical Literature Database,Wanfang Database,and CNKI database were used to search for clinical studies on the treatment of hypertension combined with atrial fibrillation by RDN combined with PVI published from January 2010to April 2023.The meta-analysis was performed using RevMan5.3software,and the sensitivity analysis and publication bias analysis were performed using Stata15.1software.Results Ten literatures with a total of 859patients were finally included.The results of the analysis showed that the recurrence rate of atrial fibrillation was reduced in the RDN combined with PVI group at 12months postoperatively compared with the PVI group(RR=0.61,95%CI 0.51to 0.72,P<0.01),and the difference in the recurrence rate of atrial fibrillation at 24months postoperatively was not statistically significant.Compared to the PVI group,patients with paroxysmal atrial fibrillation and patients with refractory hypertension had reduced recurrence rates of atrial fibrillation at 12months postoperatively in the RDN combined with PVI group(RR=0.64,95%CI 0.51to 0.81;RR=0.66,95%CI 0.52to 0.83).Compared with the PVI group,the RDN combined with PVI group had lower office systolic and diastolic blood pressures at 12months postoperatively[weigh-ted mean difference(WMD):-11.58,95%CI-18.14to-5.02 mmHg;WMD:-5.90,95%CI-8.72to-3.07mmHg],glomerular filtration rate(GFR)was higher[WMD:14.79,95%CI12.95to 16.63mL/(min 1.73·m2)],and blood creatinine,urinary albumin/urinary creatinine decreased at 6to 12 months postoperatively[WMD:-0.27,95%CI-0.36to-0.18mg/dL;WMD-50.26,95%CI-77.01to-23.52mg/g],and interventricular septal thickness,left ventricular end-diastolic internal diameter,and left ventricular mass index decreased at 6to 12months postoperatively(WMD:-1.25,95%CI-1.57to-0.93mm;WMD:-2.37,95%CI-4.63to-0.11mm;WMD:-14.59,95%CI-18.06to-11.11g/m2)(all P<0.01).Regarding safety,there was no statistically significant difference in the complication rate between the two groups(RR=1.42,95%CI 0.74to 2.75,P=0.29).Conclusion RDN combined with PVI surgery reduces the 12-month postoperative recurrence rate of atrial fibrillation in patients with hypertension combined with atrial fibrillation,but does not improve the 24-month postoperative recurrence rate of atrial fibrillation,and the combined surgery has better effectiveness and safety.