Wang Yong, Lai Tian-Wen, Xu Feng, Zhou Jie-Sen, Li Zhou-Yang, Xu Xu-Chen, Chen Hai-Pin, Ying Song-Min, Li Wen, Shen Hua-Hao, Chen Zhi-Hua
Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
State Key Lab of Respiratory Disease, Guangzhou, China.
Oncotarget. 2017 Jul 18;8(44):78031-78043. doi: 10.18632/oncotarget.19352. eCollection 2017 Sep 29.
Increasing randomized controlled trials (RCTs) indicate that bronchoscopic lung volume reduction (BLVR) is effective for severe emphysema. In this meta-analysis, we investigated the efficacy and safety of BLVR in patients with severe emphysema.
PubMed, Embase and the Cochrane Library and reference lists of related articles were searched, and RCTs that evaluated BLVR therapy VS conventional therapy were included. Meta-analysis was performed only when included RCTs ≥ 2 trials.
In total, 3 RCTs for endobronchial coils, 6 RCTs for endobronchial valves (EBV) and 2 RCTs for intrabronchial valves (IBV) were included. Compared with conventional therapy, endobronchial coils showed better response in minimal clinically important difference (MCID) for forced expiratory volume in 1s (FEV1) (RR = 2.37, 95% CI = 1.61 - 3.48, < 0.0001), for 6-min walk test (6MWT) (RR = 2.05, 95% CI = 1.18 - 3.53, p = 0.01), and for St. George's Respiratory Questionnaire (SGRQ) (RR = 2.32, 95% CI = 1.77 - 3.03, p < 0.00001). EBV therapy also reached clinically significant improvement in FEV1 (RR = 2.96, 95% CI = 1.49 - 5.87, = 0.002), in 6MWT (RR = 2.90, 95% CI = 1.24 - 6.79, p = 0.01), and in SGRQ (RR = 1.53, 95% CI = 1.22 - 1.92, p = 0.0002). Both coils and EBV treatment achieved statistically significant absolute change in FEV1, 6MWT, and SGRQ from baseline, also accompanied by serious adverse effects. Furthermore, subgroup analysis showed there was no difference between homogeneous and heterogeneous emphysema in coils group. However, IBV group failed to show superior to conventional group.
Current meta-analysis indicates that coils or EBV treatment could significantly improve pulmonary function, exercise capacity, and quality of life compared with conventional therapy. Coils treatment could be applied in homogeneous emphysema, but further trials are needed.
越来越多的随机对照试验（RCT）表明，支气管镜下肺减容术（BLVR）对重度肺气肿有效。在这项荟萃分析中，我们研究了BLVR在重度肺气肿患者中的疗效和安全性。
检索了PubMed、Embase、Cochrane图书馆以及相关文章的参考文献列表，并纳入了评估BLVR治疗与传统治疗对比的RCT。仅当纳入的RCT≥2项试验时才进行荟萃分析。
总共纳入了3项关于支气管内线圈的RCT、6项关于支气管内瓣膜（EBV）的RCT和2项关于支气管内瓣膜（IBV）的RCT。与传统治疗相比，支气管内线圈在1秒用力呼气容积（FEV1）的最小临床重要差异（MCID）方面显示出更好的反应（RR = 2.37，95%CI = 1.61 - 3.48，<0.0001），在6分钟步行试验（6MWT）方面（RR = 2.05，95%CI = 1.18 - 3.53，p = 0.01），以及在圣乔治呼吸问卷（SGRQ）方面（RR = 2.32，95%CI = 1.77 - 3.03，p < 0.00001）。EBV治疗在FEV1（RR = 2.96，95%CI = 1.49 - 5.87，= 0.002）、6MWT（RR = 2.90，95%CI = 1.24 - 6.79，p = 0.01）和SGRQ（RR = 1.53，95%CI = 1.22 - 1.92，p = 0.0002）方面也达到了临床显著改善。线圈和EBV治疗在FEV1、6MWT和SGRQ方面与基线相比均取得了统计学上显著的绝对变化，同时也伴有严重的不良反应。此外，亚组分析显示线圈组中均匀型和非均匀型肺气肿之间没有差异。然而，IBV组未能显示出优于传统组。
当前的荟萃分析表明，与传统治疗相比，线圈或EBV治疗可显著改善肺功能、运动能力和生活质量。线圈治疗可应用于均匀型肺气肿，但还需要进一步试验。
