房颤患者节律控制与心室率控制预后比较的Meta评价

Comparison of the prognosis between rhythm control and rate control in atrial fibrillation patients with Meta analysis

目的评价房颤患者节律控制与室率控制两种治疗方法预后有无差异。方法计算机检索Pubmed（2000～2010）、Cochrane Database of Systematic Reviews（2000～2010）、EMbase（2000～2010）中关于房颤患者节律控制与室率控制预后进行比较的随机对照研究（RCTs），同时筛检纳入文献的参考文献，对纳入研究的方法学进行评价。研究者对文献质量进行严格评价和资料提取，对符合质量标准的RCTs用Revman5．0软件进行Meta分析。结果6个RCTs共6615例患者纳入研究，其中节律控制组（节律组）3312例，室率控制组（室率组）3303例。Meta分析结果表明房颤患者节律组再次住院人数高于室率组。对于房颤患者节律组与室率组在全因总死亡率、发生缺血性脑卒中、发生非中枢神经系统性出血方面相关的RCTs结果显示无显著差异。结论与控制房颤的节律相比，控制心室率可以降低患者住院次数但不增加发生其他不良结局的危险性。控制心室率、联合使用抗凝药可以作为房颤患者的治疗方案。

Objective To evaluate the difference of prognosis between rhythm control and rate control in patients with atrial fibrillation. Method We searched the data from Pubmed Medline （2000- 2010）, Cochrane Database of Systematic Reviews （ 2000-2010 ）, EMbase （ 2000-2010 ） and collected ran- domized controlled trials （RCTSs） about atrial fibrillation with rhythm control and rate control. The quality of RCTSs was critically appraised and data were extracted by reviewers independently. Meta-analyses were conducted for the eligible RCTSs with Revman 5.0 software. Results Six RCTSs were included. 3312 ca- ses were in rhythm control, and 3303 cases in ventricular rate control. Ventricular rate control could de- crease the rate of hospitalization. No significant difference was found for the endpoints of death, cerebral is- chemic stroke and non-CNS bleeding, from the RCTSs. Conclusion Compared with rhythm control, rate control could decrease the risk of hospitalization and did not increase the risk of other adverse endpoints. Ventricular rate control combined with application of effective anticoagulation medicine could be a good treatment for atrial fibrillation patients.