原發性皮質醛酮症患者接受腎上腺切除術或醛固酮受體阻斷劑治療後產生新生心房顫動的差異之統合分析

Abstract

背景 原發性皮質醛酮症患者有較高的心房顫動的罹病率和其他心血管併發症。然而，對於經腎上腺切除手術或口服藥物(醛固酮受體阻斷劑)治療後，預防新生心房顫動的效果尚不清楚。這項統合分析研究的目的是評估原發性皮質醛酮症患者接受醛固酮受體阻斷劑口服藥物治療或是腎上腺切除術發生新生心房顫動的差異。 方法 在PubMed，Embase和Cochrane資料庫進行隨機分派或觀察性研究的文獻搜尋，研究調查原發性皮質醛酮症患者接受藥物治療後或手術治療後的新生心房顫動發生率。將原發性皮質醛酮症患者接受手術治療、藥物治療及一般高血壓患者的新生心房顫動發生率進行統合分析。納入研究的偏倚風險使用非隨機干預研究的偏倚風險（ROBINS-I）評估表。 結果 統合分析共檢索了37篇相關文章，其中3篇符合納入標準的研究（共2705名PA患者）被納入研究，審查過程根據PRISMA指南進行。薈萃分析結果發現，原發性皮質醛酮症患者接受醛固酮受體阻斷劑治療比手術治療，其新生心房顫動的發生率較高（固定效應模型的勝算比: 2.99, 95%信賴區間: 1.86-4.82, p < 0.001）。異質性分析（I2 = 0）其趨近同質性。經漏斗圖和Egger回歸不對稱檢驗評估，無出版性的偏誤(p = 0.91)。接受藥物治療的原發性皮質醛酮症患者與原發性高血壓患者相較下，其新生心房顫動的發生率較高（隨機效應模型的勝算比: 1.91, 95% 信賴區間: 1.11-3.29）；接受手術治療的原發性皮質醛酮症患者發生新生心房顫動的風險與原發性高血壓患者相較下，是沒有顯著相關（隨機效應模型的勝算比: 0.71, 95%信賴區間: 0.27-1.85）。 結論 原發性皮質醛酮症患者接受醛固酮受體阻斷劑治療相較於原發性皮質醛酮症患者接受手術治療或原發性高血壓患者，其新生心房顫動的發生率較高。

Background Primary aldosteronism (PA) is associated with a higher prevalence of atrial fibrillation and other cardiovascular complications. However, the effect of targeted treatment to prevent new-onset atrial fibrillation (NOAF) remains unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension (EH). Methods Randomized or observational studies that investigated the incidence rate of NOAF in PA patients receiving MRA treatment versus PA patients receiving adrenalectomy were identified in searches of PubMed, Embase and Cochrane Library. Meta-analyses of NOAF events in PA patients receiving MRA treatment, PA patients receiving adrenalectomy, and patients with EH were conducted. Results A total of 37 related studies were reviewed, of which 3 fulfilled the inclusion criteria, including a total of 2,705 PA patients. The results of meta-analysis demonstrated a higher incidence of NOAF among the PA patients receiving MRA treatment compared to the PA patients receiving adrenalectomy (odds ratio [OR]: 2.99, 95% confidence interval [CI]: 1.86-4.82, p < 0.001 in a fixed effects model). The pooled OR for the PA patients receiving MRA treatment compared to the patients with EH was 1.91 (95% CI: 1.11-3.29). The pooled OR for the PA patients receiving adrenalectomy compared to the patients with EH was 0.71 (95% CI: 0.27-1.85). Conclusion Compared to the EH patients and the PA patients receiving adrenalectomy, the patients with PA receiving MRA treatment had a higher risk of NOAF.