心室率控制与节律控制治疗心房颤动合并心力衰竭的系统评价

Systematic evaluation of rate-control versus rhythm-control in treatment of patients with atrial fibrillation and heart failure

目的对心室率控制和节律控制治疗心房颤动(房颤)合并心力衰竭(心衰)的疗效进行Meta分析。方法检索Pubmed(1966～2009年)、ScienceDirect(1966～2009年)、Cochrane图书馆临床对照试验资料数据库(1980～2009年)、Google学术网站,纳入房颤合并心衰患者以药物作为一线治疗,进行心室率控制(室率组)或节律控制(节律组)的随机对照试验,评价纳入研究的方法学,并应用Revman 5.0软件进行分析。结果共4个随机对照研究2486例患者入选。Meta分析结果显示,节律组与室率组全因病死率、心血管病死率比较,差异均无统计学意义,室率组的全因住院率低于节律组(OR=0.79,95% CI:0.66～0.94)。结论对于房颤合并心衰并以药物作为一线治疗的患者,节律控制不优于心室率控制,且增加住院概率。

Objective To carry out meta-analysis of the efficacy of rate-control and rhythm-control in treatment of patients with atrial fibrillation and heart failure. Methods Pubmed（1966-2009）, ScienceDirect （ 1966 - 2009 ）, Cochrane Library Clinical Controlled Trial Data-base （ 1980 - 2009 ）, Google scholar network station were searched. Randomized controlled trials comparing pharmacologic rhythm and rate control strategies as first-line therapy in patients with atrial fibrillation and heart failure were included. The quality of included studies was evaluated and meta-analysis was performed using Revman 5.0 software. Results Four randomized controlled trials were identified, which included a total of 2 486 patients with atrial fibrillation and heart failure. No significant difference was observed between the rate and the rhythm control groups regarding all-cause mortality and cardiovascular mortality,but rate-control strategy was associated with significantly reduced risk of hospital admissions for any cause compared with rhythm-control approach （OR = 0.79,95% CI. 0. 66-0. 94）. Conclusions With drugs as first-line therapy, rhythm control was not superior to rate control in patients with atrial fibrillation and congestive heart failure in mortality,but associated with a significantly increased probability of hospital admission.