右室间隔起搏与心尖部起搏对左室功能中远期影响的Meta分析

摘要

目的系统评价右室间隔起搏与心尖部起搏对左室功能中远期影响。方法计算机检索PubMed、EMbase及Cochrane图书馆，同时检索中国生物医学文献数据库、中国期刊全文数据库、万方数据库和中文科技期刊数据库，检索时间截至2012年12月，收集右室间隔起搏与右室心尖起搏对左室心功能影响的随机对照试验，并用Cochrane协作网推荐的质量评价体系对纳入研究进行质量评价、资料提取，采用RevMan5.1进行Meta分析。结果最终纳入20项研究，1642例患者。Meta分析结果显示，在术后12个月左室射血分数（LVEF，MD=4.00，95%CI：1.87～6.12）、术后12个月以上LVEF （MD=5.28，95%CI：2.53～8.03）、术后12个月血N末端脑钠肽前体（NT-proBNP，SMD=-0.89，95%CI：-1.56～-0.22）、术后12月左室收缩末体积（MD=-5.24，95%CI：-9.53～-0.96）、术后12月Tei指数（MD=-0.42，95%CI：-0.18～-0.05）、术后QRS时限（SMD=-1.16，95%CI：-1.64～-0.68）方面右室间隔起搏均优于右室心尖部起搏；而在术后12个月左室舒张末内径（MD=-0.52，95%CI：-1.91～0.87）、术后12个月左室舒张末体积（MD=-1.43，95%CI：-3.72～0.87）方面两者差异无统计学意义。结论相对于心尖部起搏，右室间隔起搏对左室功能影响较小；但受纳入研究质量及样本量的限制，上述结论仍需进行更多多中心、大样本、前瞻性研究进一步证实。%Objective To review systematically the mid-term and long-term influences of right ventricular septal pacing and right ventricular apex pacing on left ventricular function. Methods The databases of PubMed, Embase, Cochrane Library, CBM, CNKI, WANGFANG Database and China Scientific Journal Database (CSJD) were retrieved with computers for collecting randomized controlled trials (RCT) about the influences of right ventricular septal pacing and right ventricular apex pacing on left ventricular function. The deadline of the retrieval time was Dec. 2012. All RCT was given quality evaluation, data extraction and Meta-analysis according to the quality evaluation system recommended by Cochrane Collaboration. Results There were totally 20 RCT included involving 1642 patients, and the results of Meta-analysis showed that right ventricular septal pacing was better than right ventricular apex pacing in LVEF after operation for 12 months (MD=4.00, 95%CI:1.87~6.12), LVEF after operation for more than 12 months (MD=5.28, 95%CI:2.53~8.03), NT-proBNP after operation for 12 months (SMD=-0.89, 95%CI:-1.56~-0.22), LVESd after operation for 12 months (MD=-5.24, 95%CI:-9.53~-0.96), Tei index after operation for 12 months (MD=-0.42, 95%CI:-0.18~-0.05), and QRS duration after operation (SMD=-1.16, 95%CI:-1.64~-0.68). There was no significant difference between two methods in LVEDd after operation for 12 months (MD=-0.52, 95%CI:-1.91~0.87) and LVEDV after operation for 12 months (MD=-1.43, 95%CI:-3.72~0.87). Conclusion Right ventricular septal pacing has less influence on left ventricular function compared with right ventricular apex pacing. Because of the limitation of quality and sample quantity, more multiple-center, large-sample and prospective RCT are required for further identifying the results.