摘要
目的探讨体外心脏震波治疗对冠心病患者预后的影响。方法通过检索Pub Med、EMBASE数据库、Cochrane图书馆、Cochrane临床试验中心注册库及中文Sino Med数据库,查找心脏震波治疗对冠心病患者预后影响的随机对照临床研究,按照PRISMA声明进行,主要研究目的为评估再住院率的变化。结果本研究检索后最终纳入10项临床研究,共涉及422例患者,平均随访(5.2±4.7)个月(1~12个月)。与应用常规冠心病治疗相比,心脏震波治疗能够降低冠心病患者的加拿大心血管病学会(CCS)心绞痛分级[加权均数差(WMD)=-0.64,95%CI(-0.97,-0.31),P<0.001]和纽约心脏病协会(NYHA)心功能分级[WMD=-0.54,95%CI(-0.86,-0.23),P=0.001],增加6 min步行距离[WMD=62.00 m,95%CI(41.64,82.37),P<0.001],改善生活质量评分[WMD=12.79,95%CI(5.66,19.92),P<0.001]和左心室射血分数[WMD=5.11%,95%CI(0.18,10.03),P=0.04],减少左心室舒张末期直径[WMD=-3.99 mm,95%CI(-6.38,-1.60),P=0.001]。此外,SPECT结果显示体外心脏震波治疗能够显著改善冠心病患者的左心室心肌血流灌注评分[WMD=-8.52,95%CI(-11.98,-5.07),P<0.001]和左心室心肌代谢评分[WMD=-6.54,95%CI(-10.88,-2.21),P=0.003],降低再住院率[RR=0.35,95%CI(0.23,0.54),P<0.001]。结论体外心脏震波治疗能改善冠心病患者预后,降低再住院率,但仍需要更多大型研究验证长期的治疗效果。
Objective To evaluate the effect of cardiac shock wave therapy on prognosis in patients with coronary artery disease. Methods Relevant randomized controlled trials（RCTs） were retrieved from Pub Med,Google Scholar,Cochrane Library,and Sino Med databases. This meta-analysis was performed according to the PRISMA statement. Primary outcome was the rate of re-hospitalization. Results We identified 10 RCTs（422 patients） with a mean follow-up of（5. 2 ± 4. 7） months（1-12 months）. Overall,cardiac shock wave therapy could significantly lower the levels of CCS [weighted mean difference（WMD） =-0. 64,95% CI：-0. 97 to-0. 31,P〈0. 001],NYHA（WMD =-0. 54,95% CI：-0. 86 to-0. 53,P =0. 001）,increase the walk distance in 6 min（WMD = 62. 00 m,95% CI： 41. 64 to 82. 37,P〈0. 001）,Seattle angina questionnaire scores（WMD = 12. 79,95% CI： 5. 66 to 19. 92,P〈0. 001） and left ventricular ejection fraction（WMD = 5. 11%,95% CI： 0. 18 to 10. 03,P = 0. 04）,decrease the left ventricular end-diastolic diameter（WMD =-3. 99 mm,95% CI：-6. 38 to-1. 60,P = 0. 001）. Moreover,left ventricular perfusion scores（WMD =-8. 52 mm,95% CI：-11. 98 to-5. 07,P〈0. 001） and metabolism scores（WMD =-6. 54 mm,95% CI：-10. 88 to-2. 21,P = 0. 003） were both markedly decreased in those treated with cardiac shock wave therapy assessed by SPECT. Furthermore,rate of re-hospitalization was significantly decreased with cardiac shock wave therapy（RR = 0. 35,95% CI： 0. 23 to 0. 54,P〈0. 001）. Conclusions Cardiac shock wave therapy could improve the prognosis in patients with coronary artery disease,decrease the rate of rehospitalization. However,more larger studies are warranted to confirm the long-term effect.
作者
李鹏
谭潇
刘保逸
段春波
何青
Li Peng;Tan Xiao;Liu Baoyi;Dnan Chunbo;He Qing(Beijing Hospital ,National Center of Gerontology ,Beijing 100730, China)
出处
《中国心血管杂志》
2018年第3期208-212,共5页
Chinese Journal of Cardiovascular Medicine
关键词
体外心脏震波治疗
冠状动脉疾病
再住院率
预后
META分析
Extracorporeal cardiac shock wave therapy
Coronary artery disease
Rehospitalization
Prognosis
Meta-analysis
