中西医结合治疗原发性高血压并发心房颤动有效性和安全性的Meta分析

Efficacy and safety of traditional Chinese medicine combined with western medicine in treating essential hypertension complicated with atrial fibrillation:A Meta-analysis

目的系统评价中西医结合治疗原发性高血压并发心房颤动的有效性和安全性。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Cochrane Library、EMbase 8个数据库,同时通过手工检索等其他途径补充文献,筛选中西医结合治疗原发性高血压并发房颤的随机对照试验。采用CochraneReviewers Handbook 5.1.0偏倚风险评估工具对文献进行质量评价,借助Review Manager 5.3软件进行Meta分析。结果最终纳入11篇文献,包含1124例患者。Meta分析结果显示,中西医结合治疗能进一步提高原发性高血压并发房颤患者的治疗总有效率(RR=1.29,95%CI [1.20,1.40],P<0.000 01),减小P波离散度(MD=-4.54,95%CI [-5.67,-3.40],P<0.000 01),减小左房内径(MD=-3.06,95%CI [-4.53,-1.60],P<0.000 1),提高射血分数(MD=5.13,95%CI [4.71,5.55],P<0.000 01),降低收缩压(MD=-7.48,95%CI [-14.65,-0.31],P=0.04),降低舒张压(MD=-4.36,95%CI [-5.45,-3.27],P<0.000 01),具有较好的安全性(RR=0.65,95%CI [0.42,0.99],P=0.04)。结论中西医结合治疗对原发性高血压并发房颤患者有较好的疗效和安全性,但由于纳入研究质量普遍偏低,结论仍需更多高质量的临床研究加以证实。

Objective To systematically evaluate the efficacy and safety of traditional Chinese medicine combined with western medicine in treating essential hypertension(EF) complicated with atrial fibrillation(AF). Methods CNKI, Wanfang, VIP, CBM,PubMed, Web of Science, Cochrane Library and EMbase were retrieved to screen out the randomized controlled trials of traditional Chinese medicine combined with western medicine in treating EH with AF, other methods such as manual retrieval were used to supplement the literature. Cochrane Reviewers Handbook 5.1.0 were used to evaluate the quality of the included literatures and Review Manager 5.3 software was used for Meta-analysis. Results A total of 1124 patients in 11 RCTs were enrolled. According to Meta-analysis,traditional Chinese medicine combined with western medicine could further improve total effective rate(RR = 1.29, 95% CI [1.20, 1.40],P < 0.000 01), decrease P wave dispersion(MD =-4.54, 95% CI [-5.67,-3.40], P < 0.000 01), reduce left atrial diameter(MD =-3.06,95% CI [-4.53,-1.60], P < 0.000 1), improv ejection fraction(MD = 5.13, 95% CI [4.71, 5.55], P < 0.000 01), reduce systolic blood pressure(MD =-7.48, 95%CI [-14.65,-0.31], P = 0.04), reduce diastolic blood pressure(MD =-4.36, 95% CI [-5.45,-3.27], P <0.000 01) and it was safe for the treatment of EH complicated with AF(RR = 0.65, 95% CI [0.42, 0.99], P = 0.04). Conclusion It indicated that traditional Chinese medicine combined with western medicine showed a better efficacy and safety in the treatment of EH complicated with AF. Meanwhile, more high-quality clinical studies are still needed to verify the conclusion on account of the generally low quality of the included studies.