目的:系统评价口服中药联合美托洛尔治疗快速性心律失常的临床疗效和安全性.方法:计算机检索中国知网、万方数据知识服务平台、维普中文期刊服务平台、SinoMed数据库、PubMed、Cochrane Library共6 个数据库,筛选纳入口服中药联合美托洛尔治疗快速性心律失常的随机对照试验,采用Cochrane偏倚风险评估工具评价文献质量,Review Manager 5.4 软件进行Meta分析.结果:共纳入19 项随机对照试验,包含1 155 例患者.Meta分析结果显示,与单独使用美托洛尔相比,口服中药联合美托洛尔能够显著提高快速性心律失常患者的左室射血分数[I2=13%,MD =3.39,95%CI(2.14,4.65),P＜0.000 01],降低左房内径[I2=90%,MD =-1.99,95%CI(-3.76,-0.22),P =0.004]和24 小时平均心率[I2=95%,MD =-11.99,95%CI(-18.86,-5.13),P =0.000 6],提高中医证候有效率[I2=0%,RR =4.23,95%CI(3.05,5.92),P＜0.000 01]和临床有效率[I2=0%,RR =2.69,95%CI(1.78,4.07),P＜0.000 01],并降低中医证候总积分[I2=75%,MD =-3.28,95%CI(-4.29,-2.26),P＜0.000 01]和不良反应发生率[I2=0%,RR =0.46,95%CI(0.23,0.93),P =0.03].亚组分析显示,口服中药联合美托洛尔对辨为虚证的患者能更显著地降低左房内径[MD =-2.81,95%CI(-4.64,-0.97),P =0.003],对辨为实证[MD =-6.33,95%CI(-9.97,2.69),P =0.006]和虚实夹杂证[MD =-7.75,95%CI(-12.82,-2.68),P＜0.000 01]的患者能更显著地降低24 小时平均心率,对辨为虚证[RR =3.18,95%CI(1.80,5.62),P＜0.000 1]和虚实夹杂证[RR =2.39,95%CI(1.22,4.71),P =0.01]的患者能更显著地提高临床有效率,而其他结局指标在各亚组间无显著性差异.结论:口服中药联合美托洛尔治疗快速性心律失常疗效显著,能够明显改善患者的心功能、减轻临床和中医症状.
Objective:To systematically evaluate the clinical efficacy and safety of oral Chinese medicine combined with Metoprolol in the treatment of rapid arrhythmia.Method:Six databases including China National Knowledge Infrastructure(CNKI),Wanfang Data Knowl-edge Service Platform,VIP Chinese Journal Service Platform,SinoMed Database,PubMed,and Cochrane Library were searched by com-puter to select randomized controlled trials of oral Chinese medicine combined with metoprolol for the treatment of rapid arrhythmia.Co-chrane bias risk assessment tool was used to evaluate the quality of literature,and Meta analysis was conducted using ReviewManager 5.4 software.Result:A total of 19 randomized controlled trials were included,including 1 155 patients.The meta-analysis results showed that compared with the use of Metoprolol alone,oral Chinese medicine combined with Metoprolol can significantly improve the left ventricular ejection fraction(I2=13%,MD =3.39,95%CI[2.14,4.65],P＜0.000 01),reduce the left atrial diameter(I2= 90%,MD =-1.99,95%CI[-3.76,-0.22],P =0.004)and 24-hour average heart rate(I2=95%,MD =-11.99,95%CI[-18.86,-5.13],P =0.000 6)in patients with rapid arrhythmia,and improve the total effective rate of Chinese medicine syn-dromes(I2=0%,RR =4.26).3.95%CI[3.05,5.92],P＜0.000 01)and clinical total effective rate(I2=0%,RR =2.69,95%CI[1.78,4.07],P＜0.000 01),while reducing the total score of traditional Chinese medicine syndromes(I2=75%,MD =-3.28,95%CI[-4.29,-2.26],P＜0.000 01)and incidence of adverse reactions(I2=0%,RR =0.46,95%CI[0.23,0.93],P = 0.03).Subgroup analysis showed that the combination of oral traditional Chinese medicine and Metoprolol significantly reduced the left atrial diameter(MD =-2.81,95%CI[-4.64,-0.97],P =0.003)in patients diagnosed with deficiency syndrome,and significant-ly reduced the 24-hour average heart rate in patients diagnosed with deficiency syndrome(MD =-6.33,95%CI[-9.97,2.69],P =0.006)and those diagnosed with deficiency syndrome(MD =-7.75,95%CI[-12.82,-2.68],P＜0.000 01).Patients with solid inclusion(RR =2.39,95%CI[1.22,4.71],P =0.01)showed a more significant improvement in overall clinical efficacy,while other outcome measures showed no significant differences between subgroups.Conclusion:The combination of oral traditional Chinese medicine and Metoprolol has a significant therapeutic effect on rapid arrhythmia,which can significantly improve the patient's heart function,alleviate clinical and traditional Chinese medicine symptoms.
卢郑羽;李玉峰
北京中医药大学东直门医院,北京 101100
中医学
快速性心律失常;中药;美托洛尔;随机对照试验;Meta分析
rapid arrhythmia;traditional Chinese medicine;Metoprolol;randomized controlled trials;Meta analysis
《中医学报》 2024 (001)
219-226 / 8
10.16368/j.issn.1674-8999.2024.01.037
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