经皮肾动脉介入与药物治疗动脉粥样硬化性肾动脉狭窄有效性的Meta分析

Efficacy of percutaneous renal artery intervention and drug therapy in patients with atherosclerotic renal arterial stenosis: a Meta-analysis

目的系统评价经皮肾动脉介入与药物治疗动脉粥样硬化性肾动脉狭窄的临床疗效。方法计算机检索Pub Med、EMBASE、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库,纳入经皮肾动脉介入与药物治疗动脉粥样硬化性肾动脉狭窄有效性的随机对照研究。由两名评价员按照纳入与排除标准筛选文献,提取资料和评价质量后,采用Cochrane协作网提供的Rev Man5.3统计软件进行Meta分析。结果最终纳入8篇随机对照研究(共计2221例患者),其中介入组1101例,药物组1120例。Meta分析结果显示:介入组随访终点收缩压降低与药物组比较差异无统计学意义(WMD=0.95 mm Hg,95%CI:-0.59~2.48,P=0.23),介入组随访终点舒张压降低与药物组比较差异无统计学意义(WMD=-0.75 mm Hg,95%CI:-3.35~1.84,P=0.57),介入组肾血管事件发生率与药物组比较差异无统计学意义(OR=0.91,95%CI:0.73~1.14,P=0.41),介入组随访终点全因死亡率与药物组比较差异无统计学意义(OR=0.89,95%CI:0.70~1.13,P=0.35),介入组非致死性心肌梗死发生率与药物组比较差异无统计学意义(OR=1.01,95%CI:0.71~1.43,P=0.96),介入组充血性心力衰竭发生率与药物组比较差异无统计学意义(OR=0.87,95%CI:0.64~1.17,P=0.36),介入治疗组卒中发生率与药物组比较差异无统计学意义(OR=0.79,95%CI:0.51~1.20,P=0.26)。结论与单纯药物治疗的患者相比,介入治疗患者并不能降低其随访终点血压、随访终点全因死亡率及主要心脑肾血管不良事件发生率。

Objective To review systematically the clinical efficacy of percutaneous renal artery intervention(PRAI) and drug therapy in patients with atherosclerotic renal arterial stenosis(ARAS). Methods The databases of Pub Med, EMbase, Cochrane Library, CMB, CNKI and Wan Fang Database were retrieved with computer for collecting randomized controlled trials(RCT) about the curative effect of PRAI and drug therapy on ARAS. All selected RCT were screened by 2 reviewers according to inclusion and exclusion criteria. After extracting data and quality evaluation, the RCT were given a Meta-analysis by using Rev Man5.3 software provided by Cochrane Collaboration. Resutls There were finally 8 RCT included(2221 cases, 1101 in PRAI group and 1120 in drug group). The results of Meta-analysis showed that systolic blood pressure(SBP) decreased in PRAI group compared with drug group at followup end point(WMD=0.95 mm Hg, 95%CI:-0.59~2.48, P=0.23), and diastolic blood pressure(DBP) had no statistical difference between 2 groups(WMD=-0.75 mm Hg, 95%CI:-3.35~1.84, P=0.57). The incidence of renal vessel events had no statistical difference between 2 groups(OR=0.91, 95%CI: 0.73~1.14, P=0.41). The incidence of allcause mortality(OR=0.89, 95%CI: 0.70~1.13, P=0.35), nonfatal myocardial infarction(OR=1.01, 95%CI: 0.71~1.43, P=0.96), congestive heart failure(OR=0.87, 95%CI: 0.64-1.17, P=0.36) and stroke(OR=0.79, 95%CI: 0.51~1.20, P=0.26) had statistical difference between 2 groups. Conclusion The end point blood pressure, all-cause mortality rate and incidence of major adverse cardiovascular, cerebrovascular and renovascular events cannot be reduced in patients treated with PRAI compared with those treated with drugs only.