Phan Kevin, Jo Helen E, Xu Joshua, Lau Edmund M
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Department of Respiratory Medicine and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Heart Lung Circ. 2018 Jan;27(1):89-98. doi: 10.1016/j.hlc.2017.01.016. Epub 2017 Mar 1.
A significant number of chronic thromboembolic pulmonary hypertension (CTEPH) patients will have an inoperable disease. Medical therapy and balloon pulmonary angioplasty (BPA) have provided alternate therapeutic options for patients with inoperable CTEPH, although there are a limited number of published studies examining the outcomes. Thus, our study aims to evaluate and compare the efficacy of medical therapy and BPA in patients with inoperable CTEPH.
An electronic search of six databases was performed and the search results were screened against established criteria for inclusion into this study. Data was extracted and meta-analytical techniques were used to analyse the data.
Pooled data from RCTs revealed that medical therapy, compared with a placebo, was associated with a significant improvement of at least one functional class (p=0.038). With regards to pulmonary haemodynamics, medical therapy also resulted in a significant reduction in both mean pulmonary arterial pressure (mPAP) (p=0.002) and pulmonary vascular resistance (PVR) (p<0.001). From the included observational studies, the 6-minute walk distance (6MWD) significantly increased following medical therapy by an average of 22.8% (p<0.001). The pooled improvement in 6MWD was found to be significantly higher in the BPA group when compared to medical therapy for CTEPH (p=0.001). Pooled data from available observational studies of medical therapy or BPA all demonstrated significant improvements in mPAP and PVR for pre versus post intervention comparisons. The improvement in mPAP (p=0.002) and PVR (p=0.002) were significantly greater for BPA intervention when compared to medical therapy.
High-quality evidence supports the use of targeted medical therapy in improving haemodynamics in patients with inoperable CTEPH. There is only moderate-quality evidence from observational studies supporting the efficacy of BPA in improving both haemodynamics and exercise capacity. Further RCTs and prospective observational studies comparing medical therapy and BPA in patients with inoperable CTEPH are required.
相当数量的慢性血栓栓塞性肺动脉高压（CTEPH）患者会患有无法手术治疗的疾病。药物治疗和球囊肺动脉血管成形术（BPA）为无法手术治疗的CTEPH患者提供了替代治疗选择，尽管关于治疗结果的已发表研究数量有限。因此，我们的研究旨在评估和比较药物治疗与BPA对无法手术治疗的CTEPH患者的疗效。
对六个数据库进行电子检索，并根据既定的纳入标准对检索结果进行筛选。提取数据并使用荟萃分析技术进行数据分析。
随机对照试验的汇总数据显示，与安慰剂相比，药物治疗与至少提高一个功能分级显著相关（p = 0.038）。在肺血流动力学方面，药物治疗还导致平均肺动脉压（mPAP）（p = 0.002）和肺血管阻力（PVR）（p < 0.001）均显著降低。从纳入的观察性研究来看，药物治疗后6分钟步行距离（6MWD）显著增加，平均增加22.8%（p < 0.001）。与CTEPH的药物治疗相比，BPA组6MWD的汇总改善情况显著更高（p = 0.001）。来自现有药物治疗或BPA观察性研究的汇总数据均表明，干预前后mPAP和PVR有显著改善。与药物治疗相比，BPA干预使mPAP（p = 0.002）和PVR（p = 0.002）的改善更为显著。
高质量证据支持使用靶向药物治疗改善无法手术治疗的CTEPH患者的血流动力学。观察性研究仅有中等质量证据支持BPA在改善血流动力学和运动能力方面的疗效。需要进一步开展随机对照试验和前瞻性观察性研究，比较药物治疗与BPA对无法手术治疗的CTEPH患者的疗效。
