作者：田梅香，康静，郇轩，尹江燕，张正义

单位：

1.兰州大学第二临床医学院2.兰州大学第二医院全科医学科

Units：

1.SecondClinicalMedicalCollegeofLanzhouUniversity,Lanzhou730030,China2.GeneralMedicalDepartment,LanzhouUniversitySecondHospital,Lanzhou730030,China

关键词：

心房颤动; 高血压; 肺静脉隔离; 肾交感神经消融; 系统评价; Meta分析;

Keywords：

Atrialfibrillation;Hypertension;Pulmonaryveinisolation;Renalsympatheticdenervation;Systematicreview;Meta-analysis

CLC：

R541.75R544.1

DOI：

10.12114/j.issn.1008-5971.2023.00.071

Funds：

甘肃省自然科学基金资助项目( 20JR10RA716?)；兰州大学教育发展基金；甘肃省青年科技基金计划?(?20JR10RA762?)

摘要：

目的 再评价肺静脉隔离（PVI）联合肾交感神经消融术（RDN）治疗心房颤动（以下简称房颤）合并高血压的系统评价。方法 计算机检索PubMed、Cochrane Library、Web of Science、万方数据知识服务平台、中国知网、维普网发表的PVI联合RDN治疗房颤合并高血压的系统评价，检索时限均为建库至2022-03-31。由两名研究员严格按照文献纳入与排除标准独立筛选和提取资料，然后采用PRISMA声明、AMSTAR2量表和GRADE方法分别评价纳入文献的报告质量、方法学质量和结局指标的证据质量。结果 9篇文献的报告质量平均得分为16.5分，其中最高分22.0分、最低分11.0分；其中高质量报告1篇，中等质量报告5篇，低质量报告3篇。4篇文献的方法学质量等级为低质量，5篇文献的方法学质量等级为极低质量。9篇文献的结局指标共27个证据体，其中高质量证据体2个（7.4%），中等质量证据体6个（22.2%），低质量证据体14个（51.9%），极低质量证据体5个（18.5%）。系统评价结果显示，试验组患者房颤复发率低于对照组（P<0.05）（证据等级为低、中等、高）。试验组患者诊室收缩压、诊室舒张压降低幅度均大于对照组（P<0.05）（证据等级为低、中等）；试验组患者动态收缩压、动态舒张压降低幅度均大于对照组（P<0.05）（证据等级为极低）。试验组与对照组并发症发生率比较，差异无统计学意义（P>0.05）（证据等级为极低、低、中等）。试验组患者估算肾小球滤过率（eGFR）高于对照组（P<0.05）（证据等级为低）。试验组患者左心室舒张末期内径（LVEDD）、左心室质量指数（LVMI）下降幅度大于对照组（P<0.05）（证据等级为极低）。结论 该研究纳入的系统评价报告质量较高，但其结局指标证据质量偏低。PVI联合RDN可有效降低房颤合并高血压患者术后房颤复发率，提高患者降压效果，且安全性较高。

Abstract：

ObjectiveTo re-evaluate the systematic review of pulmonary vein isolation (PVI) combined with renal sympathetic denervation (RDN) in the treatment of atrial fibrillation (AF) combined with hypertension. MethodsSystematic reviews of PVI combined with RDN in the treatment of AF combined with hypertension published in PubMed, Cochrane Library, Web of Science, Wanfang Data, CNKI and VIP were searched by computer from inception to March 31, 2022. Two researchers independently screened and extracted data in strict accordance with the inclusion and exclusion criteria of the literature, and then the PRISMA statement, AMSTAR2 scale and GRADE method were used to evaluate the reporting quality, methodological quality and evidence quality of outcome indicators in the included literature. ResultsThe average score of the 9 literature was 16.5, with the highest score of 22.0 and the lowest score of 11.0. There were 1 high-quality report, 5 medium-quality reports and 3 low-quality reports. The methodological quality grade of 4 literature was low quality, and that of 5 literature was extremely low quality. There were 27 evidence bodies in the outcome indicators of 9 included literature, including 2 high-quality evidence bodies (7.4%) , 6 medium-quality evidence bodies (22.2%) , 14 low-quality evidence bodies (51.9%) and 5 extremely low-quality evidence bodies (18.5%) . The results of systematic evaluation showed that the recurrence rate of AF in the experimental group waslowerthanthatinthecontrolgroup(P<0.05)(theevidencelevelwaslow,mediumandhigh).Thedecreaseofclinicsystolicpressureanddiastolicpressureintheexperimentalgroupwasgreaterthanthatinthecontrolgroup(P<0.05)(theevidencelevelwaslowandmedium).Thedecreaseofdynamicsystolicpressureanddynamicdiastolicpressureintheexperimentalgroupwasgreaterthanthatinthecontrolgroup(P<0.05)(theevidencelevelwasextremelylow).Therewasnosignificantdifferenceintheincidenceofcomplicationsbetweentheexperimentalgroupandthecontrolgroup(P>0.05)(theevidencelevelwasextremelylow,lowandmedium).Theestimatedglomerularfiltrationrate(eGFR)oftheexperimentalgroupwashigherthanthatofthecontrolgroup(P<0.05)(theevidencelevelwaslow).Thedecreaseofleftventricularenddiastolicdimension(LEVDD)andleftventricularmassindex(LVMI)intheexperimentalgroupwasgreaterthanthatinthecontrolgroup(P<0.05)(theevidencelevelwasextremelylow).ConclusionThequalityofincludedsystematicreviewinthisstudyishigh,butthequalityofevidenceforoutcomeindicatorsislow.PVIcombinedwithRDNcaneffectivelyreducetherecurrencerateofAFinpatientswithAFcombinedwithhypertension,improvetheantihypertensiveeffectofpatients,andhashighsafety.

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