背景: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。在这个荟萃分析中,我们研究了BLVR对重度肺气肿患者的疗效和安全性.
方法:PubMed,搜索了Embase和Cochrane图书馆以及相关文章的参考列表,包括评估BLVR治疗与常规治疗的RCTs。仅在纳入RCTs≥2项试验时进行Meta分析。
结果:总计,3个支气管线圈的随机对照试验,包括6个支气管内瓣膜(EBV)的RCTs和2个支气管内瓣膜(IBV)的RCTs。与常规治疗相比,支气管线圈在1秒用力呼气量(FEV1)的最小临床重要差异(MCID)中显示出更好的反应(RR=2.37,95%CI=1.61-3.48,p<0.0001),6分钟步行试验(6MWT)(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FEV1也达到了临床上的显着改善(RR=2.96,95%CI=1.49-5.87,p=0.002),在6MWT中(RR=2.90,95%CI=1.24-6.79,p=0.01),和SGRQ(RR=1.53,95%CI=1.22-1.92,p=0.0002)。线圈和EBV治疗在FEV1、6MWT、和SGRQ从基线,还伴有严重的不良反应。此外,亚组分析显示,线圈组的均质和异质肺气肿之间没有差异。然而,IBV组未显示优于常规组。
结论:当前的荟萃分析表明,线圈或EBV治疗可以显着改善肺功能,锻炼能力,与常规治疗相比,生活质量。线圈治疗可应用于均匀肺气肿,但还需要进一步的试验.
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.