肾交感神经消融术治疗高血压的有效性及安全性:基于随机、假手术对照试验的Meta分析  

Effect and Safety of Renal Denervation in the Treatment of Hypertension Based on Randomized Sham-Controlled Trials:a Meta-analysis

作　　者：罗厚丽 冯健 张彦标 李先慧 薛刚 黄茜 游爽 董鸿斐 黄波 LUO Houli;FENG Jian;ZHANG Yanbiao;LI Xianhui;XUE Gang;HUANG Xi;YOU Shuang;DONG Hongfei;HAUNG Bo(Department of Radiology,Chengdu First People's Hospital,Chengdu 610041,China;Department of Critical Care Medicine,the General Hospital of Western Theater Command,Chengdu 610083,China;Department of Burn and Plastic,the General Hospital of Western Theater Command,Chengdu 610083,China)

机构地区：[1]四川省成都市第一人民医院放射科,610041 [2]西部战区总医院重症医学科,四川省成都市610083 [3]西部战区总医院烧伤整形科,四川省成都市610083

出　　处：《实用心脑肺血管病杂志》2023年第2期89-96,104,共9页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的系统评价肾交感神经消融术(RDN)治疗高血压的有效性及安全性。方法计算机检索中国知网、万方数据知识服务平台、维普网、Cochrane Library、PubMed、Embase和Web of Science公开发表的RDN治疗高血压的随机、假手术对照试验,检索时间均从建库至2021年12月。结局指标为24 h动态血压、诊室血压、家庭血压、日间血压、夜间血压及不良事件发生率。采用Stata 14.0软件进行Meta分析;针对报道结局指标数量≥10篇的文献,根据试验期间抗高血压药物使用情况、高血压类型、消融设备、消融能量、消融方式进行亚组分析。结果最终纳入10篇文献,均为英文文献,包括1636例患者,其中RND组927例、假手术组709例。Meta分析结果显示,RDN组较假手术组24 h动态收缩压降低3.04 mm Hg〔95%CI(-4.27,-1.80)mm Hg,P<0.001〕、24 h动态舒张压降低2.12 mm Hg〔95%CI(-2.88,-1.36)mm Hg,P<0.001〕、诊室收缩压降低3.83 mm Hg〔95%CI(-6.52,-1.15)mm Hg,P<0.001〕、诊室舒张压降低1.10 mm Hg〔95%CI(-1.94,-0.25)mm Hg,P<0.001〕、家庭收缩压降低4.20 mm Hg〔95%CI(-6.14,-2.27)mm Hg,P<0.001〕、家庭舒张压降低2.98 mm Hg〔95%CI(-4.31,-1.64)mm Hg,P<0.001〕、日间收缩压降低4.43 mm Hg〔95%CI(-6.22,-2.63)mm Hg,P<0.001〕、日间舒张压降低1.97 mm Hg〔95%CI(-3.10,-0.83)mm Hg,P<0.001〕、夜间收缩压降低3.39 mm Hg〔95%CI(-5.68,-1.11)mm Hg,P<0.001〕、夜间舒张压降低1.82 mm Hg〔95%CI(-3.33,-0.32)mm Hg,P=0.017〕;RDN组与假手术组不良事件发生率比较,差异无统计学意义〔危险度差(RD)=0.02,95%CI(-0.01,0.04),P=0.27〕。亚组分析结果显示,在停药、非难治性高血压、使用第一代消融设备的患者中,RDN组与假手术组24 h动态收缩压比较,差异无统计学意义(P>0.05)。结论与假手术相比,RDN能有效降低高血压患者24 h动态血压、诊室血压、家庭血压、日间血压及夜间血压,且未增加不良事件发生风险。但在试验期间停用�Objective To evaluate the effect and safety of renal denervation(RDN)in the treatment of hypertension.Methods CNKI,Wanfang Data,VIP,Cochrane Library,PubMed,Embase and Web of Science were searched for randomized sham-controlled trials of RDN in the treatment of hypertension from inception of the database to December 2021.The outcome indicators were 24 h ambulatory blood pressure,clinic blood pressure,home blood pressure,daytime blood pressure,nighttime blood pressure and incidence of adverse events.Meta-analysis was performed using Stata 14.0 software.For the outcome indicators with the number of literature≥10,subgroup analysis was performed according to the use of antihypertensive drugs during the trial,type of hypertension,ablation equipment,ablation energy,and ablation method.Results Finally,10 articles were included,all in English,including 1636 patients,including 927 in the RND group and 709 in the sham-operated group.The results of meta-analysis showed that,compared with the sham-operated group,the 24 h dynamic systolic blood pressure(SBP)of the RDN group decreased by 3.04 mm Hg[95%CI(-4.27,-1.80)mm Hg,P<0.001],the 24 h dynamic diastolic blood pressure(DBP)decreased by 2.12 mm Hg[95%CI(-2.88,-1.36)mm Hg,P<0.001],clinic SBP decreased by 3.83 mm Hg[95%CI(-6.52,-1.15)mm Hg,P<0.001],clinic DBP decreased by 1.10 mm Hg[95%CI(-1.94,-0.25)mm Hg,P<0.001],home SBP decreased by 4.20 mm Hg[95%CI(-6.14,-2.27)mm Hg,P<0.001],home DBP decreased by 2.98 mm Hg[95%CI(-4.31,-1.64)mm Hg,P<0.001],daytime SBP decreased by 4.43 mm Hg[95%CI(-6.22,-2.63)mm Hg,P<0.001],daytime DBP decreased by 1.97 mm Hg[95%CI(-3.10,-0.83)mm Hg,P<0.001],night SBP decreased by 3.39 mm Hg[95%CI(-5.68,-1.11)mm Hg,P<0.001],and night DBP decreased by 1.82 mm Hg[95%CI(-3.33,-0.32)mm Hg,P=0.017];there was no significant difference in the incidence of adverse events between RDN group and sham-operated group[risk difference(RD)=0.02,95%CI(-0.01,0.04),P=0.27].Subgroup analysis showed that there was no significant difference in 24 h SBP between RDN group and s

关 键 词：高血压 肾交感神经消融术 假手术 随机对照试验 治疗结果 META分析 

分 类 号：R544.1[医药卫生—心血管疾病]