系统评价消融与外科手术治疗原发性醛固酮增多症的有效性和安全性  

Efficacy and safety of ablation and surgery for primary hyperaldosteronism

作　　者：马如超[1] 魏涛涛[1] 陈刚[1] 宋瑞霞[1] 马贵清 林欣[1] MA Ru-chao;WEI Tao-tao;CHEN Gang;SONG Rui-xia;MA Gui-qing;LIN Xin(Department of Cardiology,Second Hospital,Lanzhou University,Lanzhou 730000,Gansu,China)

机构地区：[1]兰州大学第二医院心内科,甘肃兰州730000

出　　处：《心脏杂志》2024年第4期420-426,共7页Chinese Heart Journal

基　　金：甘肃省高等学校创新基金项目(2021B-047);兰州大学第二医院“萃英科技创新”项目(CY2020-BJ01)。

摘　　要：目的系统评价消融与外科手术治疗原发性醛固酮增多症的有效性及安全性。方法检索PubMed、EMbase、The Cochrane Library(2022年7期)、Web of Science、CBMdisc、中国知网学术总库、万方数据库中评价消融与外科手术治疗原发性醛固酮增多症有效性及安全性的相关文献,检索时限均为建库至2022年07月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险,使用Newcastle-OttawaScale(NOS)评价研究质量。采用Stata 12.0软件进行Meta分析,计量资料采用加权均数差(WMD)及95%CI表示,计数资料采用比值比(OR)及95%CI表示。共选出纳入5项相关研究,包括204例研究对象。结果消融组较外科手术组舒张压下降程度低(WMD=5.19,95%CI:0.96~9.43),但住院时间短(OR=1.6,95%CI:-2.37~-0.83),均P<0.05。而两组间其他指标包括收缩压、药物使用量、血钾、手术成功率、手术时间、术中出血量、高血压危象和总并发症无明显差异。Funnel漏斗图显示纳入的有关手术成功率的5项研究无发表偏倚,使用Begg,s及Egger’s检验也提示无发表偏倚(P值分别为0.81和0.80)。结论消融手术和外科手术在治疗原发性醛固酮增多症时安全性是相当的,外科手术可明显降低舒张压,消融可缩短住院时间。AIM To systematically evaluate the efficacy and safety of ablation and surgery in the treatment of primary aldosteronism.METHODS PubMed,EMbase,the Cochrane Library(Issue 7,2022),Web of Science,China National Knowledge Infrastructure(CNKI),and Wanfang Database were searched for literatures which evaluated the efficacy and safety of ablation and surgery in the treatment of primary aldosteronism.The retrieval time limit was from the establishment of the database to July 2022.Two reviewers independently screened the literature,extracted the data and evaluated the risk of bias of the included studies.Newcastle-ottawascale(NOS)was used to evaluate the quality of the studies and Stata 12.0 software was used for meta-analysis.Weighted mean difference(WMD)and 95%CI were used for measurement data,and odds ratio(OR)and 95%CI were used for enumeration data.RESULTS A total of 5 related studies were selected for inclusion in this study,including 204 study subjects.The results showed that the ablation group had a lower degree of decrease in diastolic blood pressure compared to the surgical group(WMD=5.19,95%CI:0.96-9.43),however,it had a shorter hospital stay(OR=1.6,95%CI:−2.37~−0.83),both P<0.05.There was no significant difference in other indicators between the two groups,including systolic blood pressure,drug use,blood potassium,surgical success rate,surgical time,intraoperative bleeding,hypertensive crisis,and total complications.The Funnel funnel plot showed no publication bias in the 5 studies included regarding surgical success rates,and the use of Begg’s and Egger’s tests also indicated no publication bias(P values 0.81 and 0.80,respectively).CONCLUSION The safety of ablative and surgical procedures for primary hyperaldosteronism is the same,surgical procedure had better diastolic blood pressure control,but ablative procedures shorten hospital stay.

关 键 词：原发性醛固酮增多症 消融 外科手术 有效性 安全性 

分 类 号：R544.1[医药卫生—心血管疾病]