胺碘酮联合美托洛尔治疗心房颤动有效性及安全性Meta分析

Meta-Analysis of Effectiveness and Safety of Amidarone combined with Metoprolol on Treatment of Atrial Fibrillation

目的评价胺碘酮联合美托洛尔治疗心房颤动的有效性及安全性。方法全面检索CNKI中国期刊全文数据库、维普中文科技期刊全文数据库、万方医药期刊数据库、Sino Med、Pub Med等数据库,同时手工检索相关杂志。按Cochrane评价员手册评价符合纳入标准的文献质量,采用Review manager 5.3.5软件进行统计分析。结果最终共纳入10篇文献,共计940例患者。结果显示,采用胺碘酮联合美托洛尔治疗心房颤动的疗效优于单用美托洛尔(Z=7.63,P<0.01);对左房内径及射血分数的改善也优于美托洛尔(P<0.01);但胺碘酮联合美托洛尔组的不良反应发生率高于单用美托洛尔。结论基于目前证据,胺碘酮联合美托洛尔口服控制心室率、改善左房内径及射血分数的效果显著优于单用美托洛尔,但其安全性逊于美托洛尔。由于本研究所纳入的文献存在质量缺陷、异质性和区域局限性,今后应开展多中心、大样本、双盲、双模拟的随机对照试验以全面评价胺碘酮联合美托洛尔治疗心房颤动的临床疗效和安全性。

Objective To evaluate the effectiveness and safety of amiodarone combined with metoprolol on treatment of atrial fibrillation. Methods We search the literatures by following database： CNKI, VIP, WanFang, SinoMed and Pubmed, and manual searching the journals. The literatures which met the inclusion criteria evaluated by Cochrane Reviewers＂ Handbook, were statistically analyzed by Review Manger 5.3 software. Results A total of 10 papers including 940 patients were enrolled. The result showed that amidarone combined with metoprolol on treatment of atrial fibrillation was superior to the metoprolol group （Z=7.63, P〈0.01）. In the aspect of left atrial diameter and ejection fraction, the amidarone combined with metoprolol group was significantly superior to the metoproM group （P〈0.01）. Unfortunately, the incidence of adverse reaction of amidarone combined with metoprolol group was significant higher than the metoproM group. Conclusion Based on current evidence, the effect of oral amidarone combined with metoprolol in improving aspect heart rate control, the left ventricular internal diameter and ejection fraction was superior to the metoprolol only, but its safety was lower than metoprolol only. For the quality defects, heterogeneity and district limitation of enrolled literatures, it is necessary to conduct multi centers, large sample, double blind, double simulated randomised controlled trials to fully evaluate the clinical efficacy and safety of amidarone combined with metoprolol for the treatment of atrial fibrillation.