参松养心胶囊联合美托洛尔治疗冠心病心律失常有效性及安全性的Meta分析

Meta analysis on the effectiveness and safety in treatment of arrhythmia of coronary heart disease with shensong yangxin capsules and metoprolol

目的系统评价参松养心胶囊联合美托洛尔治疗冠心病心律失常的有效性及安全性。方法检索中国知网、万方数据库、维普信息资源系统、中国生物医学文献数据库、PubMed、WebofScience及Cochrane图书馆,收集所有已公开发表的参松养心胶囊联合美托洛尔治疗冠心病心律失常的随机对照试验,文献检索起止时间均为建库至2018年11月。使用Jadad改良法制定的量表对纳入的研究进行质量评价,采用RevMan5.3软件对符合条件的研究进行Meta分析。结果最终纳入29项研究,样本总量为2647例。Meta分析结果显示,与单用美托洛尔相比,参松养心胶囊联合美托洛尔可显著提高临床症状疗效(OR=4.63,95%CI3.60~5.95,Z=11.99,P<0.001),明显降低治疗后缺血发生次数(MD=-3.54,95%CI-3.71^-3.37,Z=41.63,P<0.001)、缺血发生时间(MD=-6.13,95%CI-7.02^-5.23,Z=13.37,P<0.001)及B型脑钠肽(BNP)水平(MD=-59.65,95%CI-65.97^-53.34,Z=18.51,P<0.001),治疗后不良反应发生率比较差异无统计学意义(OR=0.86,95%CI0.55~1.33,Z=0.69,P=0.49)。结论参松养心胶囊联合美托洛尔较单用美托洛尔治疗冠心病心律失常可显著提高临床疗效、明显降低治疗后缺血发生次数、缺血发生时间及BNP水平,且不会增加不良反应发生率。

Objective To review systematically the effectiveness and safety on arrhythmia of coronary heart disease(CHD)treated with shensong yangxin capsules and metoprolol.Methods Retrieving from CNKI,Wanfang,VIP,CBM Chinese databases,as well as PubMed,Web of Science and Cochrane library,all of the RTCs on CHD arrhythmia treated with shensong yangxin capsules and metoprolol published were collected.The retrieval time was from the day of database establishment through to November 2018.The modified Jadad scale was adopted for the quality assessment of the included RTCs.RevMan 5.3 software was used for Meta analysis on the eligible RCTs.Results Finally,29 RTCs were included,with 2647 sample cases.Meta-analysis results showed that compared with metoprolol,the combined medication of metoprolol and shensong yangxin capsules significantly increases the clinical effects on the symptoms(OR=4.63,95%CI 3.60 to 5.95,Z=11.99,P<0.001),obviously reduces the attack frequency of ischemia(MD=-3.54,95%CI-3.71 to-3.37,Z=41.63,P<0.001),ischemia time(MD=-6.13,95%CI-7.02 to-5.23,Z=13.37,P<0.001)and BNP level(MD=-59.65,95%CI-65.97 to-53.34,Z=18.51,P<0.001).The incidence of adverse reaction after treatment was not significantly different between the two groups(OR=0.86,95%CI 0.55 to 1.33,Z=0.69,P=0.49).Conclusion Shensong yangxin capsules combined with metoprolol significantly increases the effects on clinical symptoms,reduces the frequency of ischemia,time of ischemia and BNP level after treatment and cannot increase the incidence of adverse reaction in treatment of arrhythmia of coronary heart disease.