Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema.
Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema.
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DOI：
10.1097/lbr.0000000000000872
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发表时间：
2022-07-01
影响因子：
3.3
通讯作者：
Criner, Gerard
中科院分区：
文献类型：
--
作者：
Patel, Maulin;Chowdhury, Junad;Zhao, Huaqing;Lu, Xiaoning;Roth, Stephanie;Giovacchini, Coral X.;Wahidi, Momen M.;Criner, Gerard
晚期肺气肿的药物治疗效果有限。通过随机临床试验，使用支气管内瓣膜（EBV）的支气管镜肺减容术（BLVR）报告了肺功能、呼吸困难和生活质量的改善，与外科肺减容术相比，发病率更低。我们在此提供了一项关于晚期COPD患者BLVR的荟萃分析和系统综述，使用关键词和主题词组合进行PubMed（NLM）、Embase（Elsevier）和Web of Science（Clarivate Analytics）检索。搜索仅限于过去15年，并于2020年10月23日完成。仅纳入了EB病毒肺气肿患者的安慰剂对照RCT。质量评估由两名独立评审员完成。荟萃分析纳入了9项研究，共有1383例患者，其中888例接受EBV治疗，495例接受标准治疗（SOC）药物治疗。Meta分析结果显示，EBV组FEV 1、%FEV1、SGRQ和6 MWD较SOC组明显改善，残气量（RV）较SOC组明显减少，且在短期（≤ 6个月）和长期（>= 6个月）随访中仍存在差异。当EBV患者的侧支通气为阴性/裂隙完整时（CV-/FI > 9.0%），这些改善甚至更高。EBV组的咯血和气胸发生率高于SOC组，但未导致致死性结局增加。总之，EBV对异质性肺气肿患者的预后有良好的影响，特别是在无侧支通气的患者中
Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of BLVR in advanced COPD patients PubMed (NLM), Embase (Elsevier) and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo controlled RCTs of emphysema patients with EBV were included. Quality assessment was done by two independent reviewers. 9 studies were included for the Meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in FEV1, %FEV1, SGRQ and 6MWD in EBV group compared to SOC. Residual volume (RV) had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short term(<=6months) and long-term follow-up (>=6months). These improvements were even higher when the EBV patients’ Collateral ventilation was negative/fissure was intact (CV −/FI >9 0%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared to SOC, however, did not lead to increased fatal outcomes. In conclusion, EBV has favorable effects on patients’ outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation