β受体阻滞剂治疗儿童体位性心动过速综合征的Meta分析

Meta-analysis of effect of β-blockers on treatment of postural orthostatic tachycardia syndrome in children

目的：评价β受体阻滞剂治疗儿童体位性心动过速综合征（ POTS）的总体效果。方法由北京大学第一医院儿科2名研究者根据纳入及排除标准同时、独立进行检索,于PubMed数据库（1990年至2014年）、医学文摘资料库（ EMBASE数据库1990年至2014年）、爱思唯尔（ ELSEVIER数据库1990年至2014年）、中国知网（CNKI数据库1990年至2014年）、万方数据库（1990年至2014年）收集筛选临床对照研究文献。采用Juni量表评价纳入文献质量,采用Review Manager 5.0软件进行Meta分析。结果纳入8项研究存在统计学异质性,经随机效应模型分析美托洛尔治疗组有效率与对照组相比差异有统计学意义（ RR=0.37,95%CI：0.21~0.64,P=0.0005）；将8项研究根据实验设计方案分别分为随机对照试验组/非随机对照试验组、疗效判定评分组/非评分组,并进行亚组分析,结果显示,各亚组内均不存在统计学异质性,亚组间存在明显统计学异质性,其中,非随机对照试验组中美托洛尔治疗组有效率与对照组相比差异无统计学意义（RR=0.68,95%CI：0.45~1.02,P=0.06）。结论小剂量β受体阻滞剂美托洛尔能改善POTS患者的临床症状,但仍有待大规模、多中心、统一干预方案及疗效判断标准的随机对照试验证实。

Objective To evaluate the efficacy of β-blockers in treatment of postural orthostatic tachycardia syndrome（ POTS） in children. Methods Clinical controlled trials were collected from a variety of medical electronic databases including PubMed（1990-2014）,Excerpta Medica database（EMBASE 1990-2014）,ELSEVIER（1990-2014）,China National Knowledge Internet（CNKI 1990—2014） and WANFANG（1990—2014） by 2 researchers simultaneously and respectively based on same inclusion and exclusion criteria. Studies were assessed based on the Juni scale evaluation,and the Meta-analysis was conducted using the Rev-Man 5. 0 software. Results In total 8 clinical trials were included out of over 200 papers. Possible publication bias were assessed by Funnel plot analysis. Meta analy-sis of the 8 studies demonstrated that compared with the placebo group, metoprolol group showed significantly better ef-ficacy in treating children with POTS（RR=0. 37,95%CI：0. 21-0. 64,P=0. 000 5）. Furthermore,these included trials were divided into different subgroups based on trial design （ randomized controlled trial/non-randomized con-trolled trial and Scored/N-scored） . Although no statistical heterogeneities were detected within each subgroups by the subgroup analysis,marked heterogeneities were found among subgroups; there was no significant difference of efficacy between metoprolol and placebos in treating POTS in non-randomized controlled trial group（RR=0. 68,95%CI：0. 45-1. 02,P=0. 06）. Conclusions Low-dose metoprolol is effective in treating POTS,but the conclusion still needs to be tested by more large-scaled,multi-centered and standardized clinical randomized controlled trials.