Efficacy and safety of bronchoscopic lung volume reduction therapy in patients with severe emphysema: a meta-analysis of randomized controlled trials.
Efficacy and safety of bronchoscopic lung volume reduction therapy in patients with severe emphysema: a meta-analysis of randomized controlled trials.
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支气管镜肺减容治疗对严重肺气肿患者的疗效和安全性：随机对照试验的荟萃分析
DOI：
10.18632/oncotarget.19352
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发表时间：
2017-09-29
期刊：
影响因子：
--
通讯作者：
Chen ZH
中科院分区：
文献类型：
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作者：
Wang Y;Lai TW;Xu F;Zhou JS;Li ZY;Xu XC;Chen HP;Ying SM;Li W;Shen HH;Chen ZH
越来越多的随机对照试验（RCT）表明，支气管镜肺减容术（BLVR）对重度肺气肿有效。在这项荟萃分析中，我们研究了BLVR在重度肺气肿患者中的有效性和安全性。方法检索PubMed、Embase、科克伦图书馆及相关文献，纳入评价BLVR治疗与常规治疗的RCT。仅在纳入RCT ≥ 2项试验时进行荟萃分析。结果共纳入3项关于支气管内弹簧圈的RCT、6项关于支气管内瓣膜（EBV）的RCT和2项关于支气管内瓣膜（IBV）的RCT。与常规治疗相比，支气管内弹簧圈在1 s用力呼气量（FEV 1）的最小临床重要差异（MCID）方面表现出更好的反应（RR = 2.37，95% CI = 1.61 - 3.48，p < 0.0001），6分钟步行试验（6 MWT）（RR = 2.05，95%CI = 1.18 - 3.53，p = 0.01），圣乔治呼吸问卷（SGRQ）（RR = 2.32，95%CI = 1.77 - 3.03，p < 0.00001）。EBV治疗也达到了FEV 1的临床显著改善（RR = 2.96，95% CI = 1.49 - 5.87，p = 0.002），6MWT（RR = 2.90，95% CI = 1.24 - 6.79，p = 0.01），SGRQ（RR = 1.53，95% CI = 1.22 - 1.92，p = 0.0002）。弹簧圈和EBV治疗均实现了FEV 1、6 MWT和SGRQ相对于基线的统计学显著绝对变化，也伴有严重不良反应。亚组分析显示，弹簧圈组中均质性肺气肿与非均质性肺气肿之间无差异。但IBV组未见上级优于常规组。结论：目前的荟萃分析表明，与常规治疗相比，弹簧圈或EBV治疗可显著改善肺功能、运动能力和生活质量。弹簧圈治疗可应用于同质性肺气肿，但需要进一步的试验。
BACKGROUND Increasing randomized controlled trials (RCTs) indicate that bronchoscopic lung volume reduction (BLVR) is effective for severe emphysema. In this meta-analysis, we investigated the efficacy and safety of BLVR in patients with severe emphysema. METHODS PubMed, Embase and the Cochrane Library and reference lists of related articles were searched, and RCTs that evaluated BLVR therapy VS conventional therapy were included. Meta-analysis was performed only when included RCTs ≥ 2 trials. RESULTS In total, 3 RCTs for endobronchial coils, 6 RCTs for endobronchial valves (EBV) and 2 RCTs for intrabronchial valves (IBV) were included. Compared with conventional therapy, endobronchial coils showed better response in minimal clinically important difference (MCID) for forced expiratory volume in 1s (FEV1) (RR = 2.37, 95% CI = 1.61 – 3.48, p < 0.0001), for 6-min walk test (6MWT) (RR = 2.05, 95% CI = 1.18 – 3.53, p = 0.01), and for St. George's Respiratory Questionnaire (SGRQ) (RR = 2.32, 95% CI = 1.77 – 3.03, p < 0.00001). EBV therapy also reached clinically significant improvement in FEV1 (RR = 2.96, 95% CI = 1.49 – 5.87, p = 0.002), in 6MWT (RR = 2.90, 95% CI = 1.24 – 6.79, p = 0.01), and in SGRQ (RR = 1.53, 95% CI = 1.22 – 1.92, p = 0.0002). Both coils and EBV treatment achieved statistically significant absolute change in FEV1, 6MWT, and SGRQ from baseline, also accompanied by serious adverse effects. Furthermore, subgroup analysis showed there was no difference between homogeneous and heterogeneous emphysema in coils group. However, IBV group failed to show superior to conventional group. CONCLUSIONS Current meta-analysis indicates that coils or EBV treatment could significantly improve pulmonary function, exercise capacity, and quality of life compared with conventional therapy. Coils treatment could be applied in homogeneous emphysema, but further trials are needed.