β-受体阻断剂治疗血管迷走性晕厥的Meta分析

Meta-analysis of beta-adrenoceptor blockers for the treatment of vasovagal syncope

目的:通过Meta分析的方法综合评价β-肾上腺素能受体阻断剂(简称β-受体阻断剂)治疗血管迷走性晕厥的治疗效果,为临床应用提供可参考的循证医学证据。方法:制定纳入及筛选文献的标准,从PubMed(1968至2007年)、EMBASE(1991至2007年)、Ovid(1990至2007年)、Elsevier(1990至2007年)和中国期刊全文数据库(CNKI,1990至2007)中筛选符合标准的文献,用Juni量表进行质量评估,采用Review Manager4.2分析软件进行定向综合分析。疗效判定指标为随访期限内是否出现复发或者直立试验(head-up tilt test,HUT)是否转阴。结果以相对危险度(relative risk,RR)或比值比(oddratio,OR)及其95可信区间(confidence interval,CI)表示,P<0.05为差异有统计学意义。结果:数据库中共筛选出符合要求的文献13篇,中文文献均来自CNKI,英文文献中有5篇来自于PubMed,2篇来自于Elsevier,这7篇中的2篇同时来自于EMBASE。经过漏斗图分析,可能存在发表偏倚。Meta分析结果显示:(1)综合分析11项β-受体阻断剂治疗血管迷走性晕厥的随机对照试验(randomized controlled trials,RCT),治疗组(460例)晕厥的复发率低于对照组(371例),RR=0.61,95CI为0.39～0.96,P=0.03;(2)综合分析7项β-受体阻断剂治疗血管迷走性晕厥RCT表明,治疗组(166例)在随访结束时HUT的转阴率高于对照组(163例),OR=9.15,95CI为3.75～22.31,P<0.01。结论:本研究结果支持β-受体阻断剂可能是治疗血管迷走性晕厥的有效药物,有待更大规模、设计更精确严格、多中心的随机对照试验进一步分析并研究其疗效。

Objective：To summarize present randomized controlled trials and assess the effect of beta- adrenoceptor blockers on vasovagal syncope using meta-analysis method. Methods： According to inclusion and exclusion criteria, articles were selected from medical electronic databases searching, including PubMed （ 1968 - 2007）, EMBASE （ 1991 - 2007）, Elsevier （ 1990 - 2007） and CNKI （ 1990 - 2007）. Randomized controlled trials （RCTs） were assessed based on the Juni assessment. Meta-analysis was completed using software Review Manager 4. 2. Indication for evaluating effect was recurrence of syncope during follow-up or response in head-up tilt test （HUT）. The results were stated as relative risk （RR） or odd ratio （OR） and their 95% confidence interval （CI） , and P 〈0. 05 showed significant differences. Results： Thirteen RCTs were selected finally. Funnle polt analysis showed publication bias might exist. Meta-analysis of 11 RCTs, including totally 460 patients in treatment group and 371 patients in control group, indicated patients in treatment group had lower rate of syncope recurrence as compared with control group （RR = 0. 61, 95% CI： 0. 39 - 0. 96, P = 0. 03）. From 7 RCTs, including 166 patients in treatment group and 163 in control group, meta-analysis explored that patients in treatment group had higher rate of negative response in HUT at the end-point of follow-up as compared with control group （ OR =9. 15, 95% CI： 3.75 -22. 31, P 〈0.01 ）. Conclusion： The currently published RCTs support that beta-adrenoceptor blockers can be effective treatment of vasovagal syncope though the medicine was supposed to be not useful according to some well controlled studies. So, further large-scale muhicentre and better designed study were still expected to give more convincing evidence.