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目的:本研究旨在探讨心脏再同步化治疗(CRT)联合植入式心内除颤仪(ICD)治疗(CRT-D)对心功能不全患者临床状态和再住院率方面的作用。方法:对Medline,Embase,The Cochrane Library,美国食品药物管理局数据库和中国维普期刊数据库进行系统检索,检索的截止时间为2012-10-31。本研究的终点是CRT-D和ICD治疗对心力衰竭(心衰)临床状态的改善情况和再住院率。结果:该研究入选了6个前瞻性随机对照临床研究进行荟萃分析(5 273例)。所有入选研究患者均接受指南推荐的心衰药物治疗。荟萃分析结果显示,CRT-D组患者的临床状态改善程度明显高于ICD组(P<0.01)。在NYHAⅠ～Ⅱ级的亚组人群中,CRT-D改善临床状态的优势并不明显(WMD:0.19;95%CI:-3.89～4.72),而在NYHAⅢ～Ⅳ级,CRT-D组患者临床状态的改善程度似乎更加显著(P<0.001)。CRT-D组的患者再住院率明显低于ICD组(P<0.01)。在NYHAⅠ/Ⅱ级的亚组中,CRT-D组在再住院率这一终点上的优势仍然明显(P<0.01)。然而在NYHAⅢ/Ⅳ级亚组中(随访时间仅6个月),再住院率在两组之间似乎无显著差异(P>0.05)。结论:在药物治疗的基础上,CRT-D治疗与单独的ICD治疗相比,能更显著地改善心衰患者的临床状况并降低再住院率。
PURPOSE: This study was designed to investigate the role of cardiac resynchronization therapy (CRT) in combination with implantable intracardiac defibrillator (ICD) therapy (CRT-D) in clinical status and rehospitalization rates in patients with cardiac insufficiency. Methods: The databases of Medline, Embase, The Cochrane Library, the FDA and China Vip Periodicals Database were systematically searched. The deadline for searching is 2012-10-31. The end point of this study was the improvement in clinical status and rehospitalization of CRT-D and ICD for heart failure (heart failure). RESULTS: Six prospective RCTs were included in the meta-analysis (5,273 cases). All patients enrolled in the study received guidelines for treatment of heart failure medication. The results of meta-analysis showed that the clinical status of CRT-D group was significantly improved than that of ICD group (P <0.01). Among NYHA class I to II subgroups, the clinical benefit of CRT-D was not significant (WMD: 0.19; 95% CI: -3.89 to 4.72), whereas in patients with NYHA class III-IV, CRT-D Status improvement seems to be more significant (P <0.001). The rehospitalization rate in CRT-D group was significantly lower than that in ICD group (P <0.01). In the NYHA class I / II subgroup, the advantage of the CRT-D group at the end of rehospitalization was still significant (P <0.01). However, there was no significant difference in rehospitalization rates between NYHA class III / IV subgroups (follow-up of only 6 months) between the two groups (P> 0.05). CONCLUSIONS: Based on the drug treatment, CRT-D treatment can significantly improve the clinical status and reduce the rate of rehospitalization in patients with heart failure compared with ICD alone.