经皮间隔心肌消融术与室间隔心肌切除术治疗肥厚型梗阻性心肌病的Meta分析

摘要

目的 综合评价国内外近十年来经皮间隔心肌消融术(PTSMA)与室间隔心肌切除术(VSM)治疗肥厚型梗阻性心肌病(HOCM)的疗效.方法 通过文献检索获得有关PTSMA 与VSM治疗HOCM的研究文献,分析比较两种方法对HOCM患者左心室流出道压差(LVOTPG)、室间隔厚度(IVS)、心功能分级(NYHA分级)及治疗后不良反应的指标有无差异.结果 有7 篇文献进入Meta 分析,共获得病例362 例,其中PTSMA 组199 例,VSM组163 例.Meta 分析结果显示,两组患者LVOTPG、IVS、NYHA分级变化及不良反应基本相同,但VSM组结果更接近正常.敏感性分析显示两组在LVOTPG、IVS 及NYHA分级水平的差异结果可靠.结论 PTSMA治疗HOCM的疗效略低于VSM,但仍为非创性治疗HOCM的有效方法.%Objective To synthetically evaluate the efficacy of percutaneous transluminal septal myocardial ablation (PTSMA) and ventricular septal myectomy (VSM) in hypertrophic obstructive cardiomyopathy (HOCM) at domestically and overseas over the past decades. Methods Through literature searching, the literatures about treatment of PTSMA and VSM in HOCM were obtained. Meta analysis was used to compare the differences of left ventricular outflow tract pressure gradient (LVOTPG), interventricular septal thickness (IVS), NYHA class and postoperative adverse reactions through quantitative analysis before and after treatment in two groups. Results There were 7 literatures into the meta-analysis, involving a total of 362 patients, including 199 cases in PTSMA group and 163 cases in VSM group. Meta-analysis showed no significant differences in changes of LVOTPG, IVS, NYHA class and postoperative adverse reactions before and after treatment in two groups, but the results in VSM group was closer to normal. The sensitivity analysis showed that the differences of changes of LVOTPG, IVS, NYHA class and postoperative adverse reactions in two groups were reliable. Conclusion Though the efficacy of PTSMA is temporarily slightly lower than that of VSM in HOCM, it is still an effective method of non-invasive treatment.