摘要
目的:系统评价中西医结合治疗心房颤动的有效性和安全性,并进行用药规律分析。方法:计算机检索中国知网、万方、维普、PubMed、the Cochrane Library、EMbase、Web of Science数据库,检索时限从建库至2021年10月已发表的,关于中医药或中西医结合治疗心房颤动的随机对照试验。试验组采用口服中药汤剂+常规西药治疗,对照组采用常规西药治疗,根据纳入与排除标准筛选后采用自制的表格提取有效数据。采用RevMan 5.4软件进行偏倚风险评估和Meta分析,采用Excel和SPSS软件分析纳入研究的中药处方用药规律。结果:共纳入60项研究,包括4 578例病人,其中试验组2 313例病人,对照组2 265例病人。纳入文献的质量普遍较低,发表偏倚较大。Meta分析结果显示:与对照组比较,试验组心房颤动发作次数减少[MD=-2.06,95%CI(-2.85,-1.27),P<0.000 01],心房颤动转复率提高[OR=2.78,95%CI(1.59,4.88),P=0.000 3],平均心率降低[MD=-5.04,95%CI(-7.19,-2.89),P<0.000 01],中医证候积分[MD=-3.84,95%CI(-4.67,-3.00),P<0.000 01]和左房内径[MD=-1.92,95%CI(-2.66,-1.19),P<0.000 01]降低,左室射血分数提高[MD=2.47,95%CI(0.32,4.63),P=0.02],不良反应发生率降低[OR=0.27,95%CI(0.18,0.40),P<0.000 01]。对处方进行数据挖掘,发现麦冬、丹参、桂枝、黄芪等益气养阴、活血化瘀药物使用较多。结论:现有证据表明,中西医结合对比单纯使用西药治疗心房颤动,可进一步减少心房颤动发作,提高转复率,并能改善病人心功能,提高病人生存质量,且未增加不良反应发生率。
Objective:To systematically evaluate the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of atrial fibrillation and to analyze medication regularity.Methods:The databases of CNKI,WanFang,VIP,PubMed,the Cochrane Library,EMbase,and Web of Science were searched from the establishment of the database to October 2021 to retrieve randomized controlled trials(RCTs)about traditional Chinese medicine or integrated traditional Chinese and western medicine in the treatment of atrial fibrillation.The experimental group was treated with oral decoction of traditional Chinese medicine and conventional western medicine,and the control group was treated with conventional western medicine.After screening,the effective data was extracted using a self-made chart according to the inclusion and exclusion criteria.RevMan 5.4 software was used for Meta-analysis and risk of bias.Excel and SPSS were used to analyze the prescription medication regularity of traditional Chinese medicine.Results:A total of 60 literatures were included,including 4578 patients,with 2313 cases in the experimental group and 2265 cases in the control group.The quality of the included literatures was generally low and publication bias was high.The results of Meta-analysis showed that compared with the control group,in the experimental group the number of atrial fibrillation episodes[MD=-2.06,95%CI(-2.85,-1.27),P<0.00001]was decreased,the rate of atrial fibrillation conversion[OR=2.78,95%CI(1.59,4.88),P=0.0003]was increased,mean heart rate[MD=-5.04,95%CI(-7.19,-2.89),P<0.00001]was decreased,syndrome scores of traditional Chinese medicine[MD=-3.84,95%CI(-4.67,-3.00),P<0.00001]was decreased,left atrial internal diameter[MD=-1.92,95%CI(-2.66,-1.19),P<0.00001]was decreased,left ventricular ejection fraction[MD=2.47,95%CI(0.32,4.63),P=0.02]was decreased and the incidence of adverse events[OR=0.27,95%CI(0.18,0.40),P<0.00001]was decreased.Data mining of prescriptions revealed that drugs about benefit Qi and nourish Yin,invigorate blood stasis,such as Ophiopogon japonicus,Salvia miltiorrhiza,Cinnamomi ramulus,Astragalus membranaceus were used more often.Conclusion:Compared with western medicine alone,integrated traditional Chinese and western medicine in the treatment of atrial fibrillation could further reduce the episodes of atrial fibrillation,increase the rate of conversion,and improve the patients′cardiac function and the quality of survival without increasing the incidence of adverse events.
作者
付荩毅
张菀桐
曲华
苏文文
李睿
翁维良
FU Jinyi;ZHANG Wantong;QU Hua;SU Wenwen;LI Rui;WENG Weiliang(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《中西医结合心脑血管病杂志》
2023年第8期1345-1356,共12页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
国家重点研发计划项目(No.2018YFC1706006)
中国中医科学院科技创新工程项目(No.CI2021A04703)。
关键词
心房颤动
中西医结合
中药汤剂
疗效
安全性
META分析
atrial fibrillation
integrated traditional Chinese and western medicine
oral decoction of traditional Chinese medicine
efficacy
safety
Meta-analysis
