稳心颗粒治疗慢性心力衰竭合并室性心律失常的Meta分析

Meta-analysis of Wenxin Granules in the Treatment of Chronic Heart Failure Complicated with Ventricular Arrhythmia

目的:系统评价稳心颗粒联合常规西药治疗慢性心力衰竭合并室性心律失常的有效性和安全性。方法:计算机检索The Cochrane Library、PubMed、Embase、国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、SinoMed数据库,搜集稳心颗粒治疗慢性心力衰竭合并室性心律失常的相关随机对照试验(RCT),检索时限均从建库至2021年4月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入19个RCT,包括1605例患者。Meta分析结果显示:在常规西药治疗基础上联用稳心颗粒,可显著提升临床疗效(RR=1.25,95%CI为1.19~1.32,P<0.00001)、提高左室射血分数(WMD=7.46,95%CI为6.91~8.00,P<0.0001)、减少24 h室性早搏总数(SMD=-2.05,95%CI为-3.73~-0.37,P=0.02)、降低静息心率(WMD=-7.97,95%CI为-10.51~-5.42,P<0.0001)、降低N端脑利尿钠肽前体水平(SMD=-1.29,95%CI为-1.66~-0.93,P<0.0001)、减小左室舒张末期内径(WMD=-3.31,95%CI为-5.15~-1.47,P=0.0004)。2组患者不良反应发生率比较,观察组优于对照组,差异有统计学意义(RR=0.49,95%CI为0.34~0.71,P=0.0002)。结论:稳心颗粒联合常规西药治疗慢性心力衰竭合并室性心律失常可提高临床疗效,且安全性较高。受纳入研究的数量和质量的限制,本研究结论尚需开展更多高质量研究予以证实。

Objective:To systematically review the effect and safety of Wenxin Granules combined with conventional Western medicine in the treatment of chronic heart failure complicated with ventricular arrhythmia.Methods:The Cochrane Library,PubMed,Embase,China National Knowledge Infrastructure(CNKI),China Science Periodical Database(CSPD),Chinese Citation Database(CCD),and SinoMed were retrieved from inception to April 2021 for relevant randomized controlled trials(RCTS)of Wenxin Granules in the treatment of chronic heart failure complicated with ventricular arrhythmia.Two reviewers independently screened the literature,extracted data and assessed the risk of bias of included studies.Then,meta-analysis was performed by using RevMan 5.3 software.Results:A total of 19 RCTs were included,including 1605 patients.The results of meta-analysis showed that the combined use of Wenxin Granules and conventional Western medicine treatment could significantly increase the total efficacy(RR=1.25,95%CI was 1.19 to 1.32,P<0.00001),increase the left ventricular ejection fraction(WMD=7.46,95%CI was 6.91 to 8.00,P<0.0001),decrease the total 24-h ventricular premature beat(SMD=-2.05,95%CI was-3.73 to-0.37,P=0.02),lower the resting heart rate(WMD=-7.97,95%CI was-10.51 to-5.42,P<0.0001),lower the N-terminal pro-brain natriuretic peptide levels(SMD=-1.29,95%CI was-1.66 to-0.93),P<0.0001),and reduce the left ventricular end-diastolic diameter(WMD=-3.31,95%CI was-5.15 to-1.47,P=0.0004).According to the comparison of the incidence of adverse reactions in the two groups,the observational group was better than the control group,and the difference was statistically significant(RR=0.49,95%CI was 0.34 to 0.71,P=0.0002).Conclusion:Wenxin Granules combined with conventional Western medicine can improve the clinical efficacy and safety of the treatment of chronic heart failure complicated with ventricular arrhythmia.Due to the limitation of the number and quality of included studies,the conclusion of this study need to be confirmed by more high-quality studies.