紫杉醇涂层球囊与传统球囊血管成形术治疗功能不良的透析动静脉内瘘：一项随机对照试验的系统评价和荟萃分析

Paclitaxel coated balloon versus conventional balloon angioplasty in dysfunctional dialysis arteriovenous fistula: a systematic review and meta-analysis of randomized controlled trials.

作者信息

Luo Chuxuan, Liang Mingzhu, Liu Yueming, Zheng Danna, He Qiang, Jin Juan

机构信息

Division of Health Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, China.

Department of Nephrology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.

出版信息

Ren Fail. 2022 Dec;44(1):155-170. doi: 10.1080/0886022X.2022.2029487.

PURPOSE

To compare the efficacy and safety between paclitaxel coated balloon (PCB) angioplasty and conventional balloon (CB) angioplasty in the treatment of dysfunctional arteriovenous fistula (AVF).

METHODS

We searched four major electronic databases (PubMed, EMBASE, Web of Science and the Cochrane Library) for randomized controlled trials (RCTs) published from inception through November 28, 2021. Outcomes of interest included target lesion primary patency (TLPP), technical success and all-cause mortality. The STATA package version 15.1 was utilized to undertake meta-analyses.

RESULTS

Fourteen RCTs totaling 1535 patients were analyzed. The available data showed that there were no significant differences of TLPP rates at 3, 6, 9 and 12 months between the PCB group and the CB group (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.93-1.07, = 1.000, = 33.5%, Cochrane test = 0.185, fixed-effect model; RR 1.17, 95% CI 0.99-1.39, = 0.065, = 75.4%, Cochrane test = 0.000, random-effect model; RR 0.81, 95% CI 0.35-1.89, = 0.625, = 62.8%, Cochrane test = 0.045, random-effect model; RR 1.19, 95% CI 0.97-1.47, = 0.096, = 40.5%, Cochrane test = 0.071, random-effect model). In addition, two groups had similar technical success rates (RR 1.00, 95% CI 0.97-1.03, = 1.000, = 0.0%, Cochrane test = 0.596, fixed-effect model) and all-cause mortality rates (RR 1.00, 95% CI 0.54-1.84, = 1.000, = 0.0%, Cochrane test = 0.599, fixed-effect model).

CONCLUSIONS

PCB angioplasty did not appear to convey any obvious advantage over CB angioplasty in the treatment of dysfunctional AVF. However, further multi-center, large-scale and well-designed RCTs are needed to prove outcomes.

目的

比较紫杉醇涂层球囊（PCB）血管成形术与传统球囊（CB）血管成形术治疗功能失调动静脉内瘘（AVF）的疗效和安全性。

方法

我们检索了四个主要电子数据库（PubMed、EMBASE、科学网和考克兰图书馆），以查找从数据库建立至2021年11月28日发表的随机对照试验（RCT）。感兴趣的结局包括靶病变原发通畅率（TLPP）、技术成功率和全因死亡率。使用STATA 15.1软件包进行荟萃分析。

结果

分析了共1535例患者的14项RCT。现有数据显示，PCB组和CB组在3、6、9和12个月时的TLPP率无显著差异（风险比（RR）1.00，95%置信区间（CI）0.93 - 1.07，P = 1.000，I² = 33.5%，考克兰Q检验 = 0.185，固定效应模型；RR 1.17，95%CI 0.99 - 1.39，P = 0.065，I² = 75.4%，考克兰Q检验 = 0.000，随机效应模型；RR 0.81，95%CI 0.35 - 1.89，P = 0.625，I² = 62.8%，考克兰Q检验 = 0.045，随机效应模型；RR 1.19，95%CI 0.97 - 1.47，P = 0.096，I² = 40.5%，考克兰Q检验 = 0.071，随机效应模型）。此外，两组的技术成功率（RR 1.00，95%CI 0.97 - 1.03，P = 1.000，I² = 0.0%，考克兰Q检验 = 0.596，固定效应模型）和全因死亡率（RR 1.00，95%CI 0.54 - 1.84，P = 1.000，I² = 0.0%，考克兰Q检验 = 0.599，固定效应模型）相似。