心脏再同步化治疗改善心力衰竭的荟萃分析  

The meta-analysis of cardiac resynchronization therapy plus implantable cardioverter defibrillator in patients with heart failure

作　　者：付潇[1] 陈少杰[1] 殷跃辉[1] 

机构地区：[1]重庆医科大学附属第二医院心内科,重庆400010

出　　处：《临床心血管病杂志》2013年第11期828-832,共5页Journal of Clinical Cardiology

摘　　要：目的:本研究旨在探讨心脏再同步化治疗(CRT)联合植入式心内除颤仪(ICD)治疗(CRT-D)对心功能不全患者临床状态和再住院率方面的作用。方法:对Medline,Embase,The Cochrane Library,美国食品药物管理局数据库和中国维普期刊数据库进行系统检索,检索的截止时间为2012-10-31。本研究的终点是CRT-D和ICD治疗对心力衰竭(心衰)临床状态的改善情况和再住院率。结果:该研究入选了6个前瞻性随机对照临床研究进行荟萃分析(5 273例)。所有入选研究患者均接受指南推荐的心衰药物治疗。荟萃分析结果显示,CRT-D组患者的临床状态改善程度明显高于ICD组(P<0.01)。在NYHAⅠ～Ⅱ级的亚组人群中,CRT-D改善临床状态的优势并不明显(WMD:0.19;95%CI:-3.89～4.72),而在NYHAⅢ～Ⅳ级,CRT-D组患者临床状态的改善程度似乎更加显著(P<0.001)。CRT-D组的患者再住院率明显低于ICD组(P<0.01)。在NYHAⅠ/Ⅱ级的亚组中,CRT-D组在再住院率这一终点上的优势仍然明显(P<0.01)。然而在NYHAⅢ/Ⅳ级亚组中(随访时间仅6个月),再住院率在两组之间似乎无显著差异(P>0.05)。结论:在药物治疗的基础上,CRT-D治疗与单独的ICD治疗相比,能更显著地改善心衰患者的临床状况并降低再住院率。Objective：To investigate the role of CRT-D therapy on the improvement of clinical status and rehospitalization rate,as relative to ICD therapy alone,in patients with heart failure.Method：Meta-analysis was conducted by searching the database of Medline,Embase,the Cochrane Library,and US Food and Drug Administration website for published studies up to 31October 2012.The end of the study is CRT-D and ICD therapy for heart failure improvement of clinical status and rehospitalization rates.Result：Six studies（n=5 273）were included.All patients enrolled in the study underwent heart failure guidelines recommending drug treatment.Overall,the clinical status of patients in CRT-D group was significantly improved as compared with that in ICD group（P0.01）,meanwhile,the rehospitalization rate in CRT-D group was significantly decreased（P0.01）.In NYHAⅠ-Ⅱgrade subgroup populations,CRT-D to improve clinical status advantage is not obvious（WMD：0.19;95%CI：-3.89～4.72）,but in NYHA Ⅲ-Ⅳ,it seems to be more significant improvement（P0.001）.Patients rehospitalization rate in CRT-D group was significantly lower than the ICD group（P0.01）.In NYHA Ⅰ-Ⅱgrade subgroup,patients rehospitalization rate in CRT-D were still significantly（P0.01）,but in NYHA Ⅲ-Ⅳ（follow up only 6months）,there were no significant difference between them（P0.05）.Conclusion：Compared with ICD therapy,CRT-D therapy can improve the patients′clinical status and reduce the rehospitalilaztion rate in patients with heart failure on the basis of pharmacotherapy.

关 键 词：心力衰竭 心脏再同步化治疗 临床状态 再住院率 

分 类 号：R541.6[医药卫生—心血管疾病]