Iftikhar Imran H, McGuire Franklin R, Musani Ali I
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina, Columbia, SC, USA
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina, Columbia, SC, USA.
Chron Respir Dis. 2014 Nov;11(4):237-45. doi: 10.1177/1479972314546766. Epub 2014 Aug 21.
Over the last several years, numerous trials have been carried out to check the efficacy of one-way valves in the management of advanced emphysema. While the design of the valves has not altered much, by selectively studying these valves in a select group of participants, such as those with and without intact fissures (FI+ and FI-), and by using different procedural techniques, our understanding of the valves has evolved. In this meta-analysis, we sought to study the effect of these factors on the efficacy of one-way valves. From PubMed and Embase, we included only those studies that provided separate data on fissure integrity or collateral ventilation. Our study outcomes included the mean change in forced expiratory volume in first second (FEV1), 6-minute walk distance (6MWD) and the St George's Respiratory Questionnaire (SGRQ). In the FI+ subgroup of participants, the pooled standardized mean difference in FEV1, 6MWD, and SGRQ were 0.50 (95% confidence interval (CI): 0.34 to 0.67), p ≤ 0.001, 0.29 (95% CI: 0.13 to 0.45), p ≤ 0.001 and -6.02 (95% CI: -12.12 to 0.06), p = 0.05, respectively. In comparison, these results were superior to the FI- subgroup of participants. A separate analysis of the FI+ subgroup based on lobar occlusion versus nonlobar occlusion favored the former for superior efficacy. The preliminary findings of our meta-analysis confirm that one-way valves perform better in a select group of patients who show intact fissures on lung imaging pretreatment and in those who achieve lobar occlusion.
在过去几年中，已经进行了大量试验来检验单向阀在晚期肺气肿治疗中的疗效。虽然阀门的设计变化不大，但通过在特定的参与者群体中选择性地研究这些阀门，例如有和没有完整肺裂（FI+和FI-）的参与者，并使用不同的操作技术，我们对阀门的理解已经有所发展。在这项荟萃分析中，我们试图研究这些因素对单向阀疗效的影响。从PubMed和Embase数据库中，我们只纳入了那些提供了关于肺裂完整性或侧支通气单独数据的研究。我们的研究结果包括第一秒用力呼气量（FEV1）、6分钟步行距离（6MWD）和圣乔治呼吸问卷（SGRQ）的平均变化。在FI+参与者亚组中，FEV1、6MWD和SGRQ的合并标准化平均差分别为0.50（95%置信区间（CI）：0.34至0.67），p≤0.001；0.29（95%CI：0.13至0.45），p≤0.001；以及-6.02（95%CI：-12.12至0.06），p = 0.05。相比之下，这些结果优于FI-参与者亚组。基于肺叶闭塞与非肺叶闭塞对FI+亚组进行的单独分析显示，前者疗效更佳。我们荟萃分析的初步结果证实，单向阀在肺成像预处理时显示有完整肺裂的特定患者群体以及实现肺叶闭塞的患者中表现更好。
