胺碘酮联合螺内酯与单用胺碘酮治疗阵发性房颤的Meta分析

Meta-analysis of effectiveness and safety of amiodarone combined with spirolactone versus amiodarone alone in treatment of paroxysmal atrial fibrillation

目的系统评价胺碘酮联合螺内酯与单用胺碘酮治疗阵发性房颤的临床效果及安全性。方法计算机检索中国生物医学文献数据库、中国期刊全文数据库、维普数据库、万方数据库、PubMed、Cochrane Library,查找所有比较胺碘酮联合螺内酯与单用胺碘酮对阵发性房颤患者治疗的随机对照试验。检索时间均为建库至2016年10月。同时手工检索纳入文献的参考文献。按纳入排除标准由两名研究者独立进行筛选,并提取资料,采用改良的Jadad量表评价纳入研究的质量,采用RevMan 5.3软件进行Meta分析。结果共纳入4篇文献,均为随机对照研究,总共388例患者。Meta分析结果显示:观察12个月,与单用胺碘酮(对照组)相比,胺碘酮联合螺内酯(试验组)具有更好的窦性心律维持率(OR=0.38,95%CI:0.22~0.67,P=0.0007),并且可以显著延缓左心房内径扩大(WMD=-1.72,95%CI:-2.14^-1.30,P<0.000 01),而两者安全性无统计学差异(OR=0.66,95%CI:0.11~4.03,P=0.65)。结论胺碘酮联合螺内酯比单用胺碘酮能够更好地维持窦性心律,并且能够延缓左心房内径扩大;而两组安全性无显著差异。受纳入研究的数量及质量所限,该结论仍需开展更大样本、多中心的随机对照试验加以论证。

Objective To systematically review the effectiveness and safety of amiodarone combined with spirolactone versus amiodarone alone in the treatment of paroxysmal atrial fibrillation.Methods The databases of PubMed,Cochrane Library,WanFang Data,CNKI,and VIP were searched by computer to identify articles published up to October2016that reported randomized controlled trials(RCTs)on amiodarone combined with spirolactone versus amiodarone alone for treating paroxysmal atrial fibrillation.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data,and assessed the methodological quality of the included studies using the modified Jadad scale.Then meta-analysis was conducted using RevMan5.3software.Results Four RCTs involving388patientswere included.The meta-analysis showed that compared with the single use of amiodarone(control group),the combination treatment(test team)was associated with comparable safety(OR=0.66,95%CI:0.11-4.03,P=0.65),significantly higher maintenance rate of sinus rhythm(OR=0.38,95%CI:0.22-0.67,P=0.0007),and significantly delayed enlargement of left atrial diameter(WMD=-1.72,95%CI:-2.14--1.30,P<0.00001).Conclusion The existing evidence suggests that amiodarone combined with spirolactone is better than amiodarone alone in the treatment of paroxysmal atrial fibrillation with regard to increasing the maintenance rate of sinus rhythm and significantly delaying the enlargement of left atrial diameter,although their safety is comparable.