Pittler Max H, Schmidt Katja, Ernst Edzard
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, United Kingdom.
Am J Med. 2003 Jun 1;114(8):665-74. doi: 10.1016/s0002-9343(03)00131-1.
The aim of this meta-analysis was to assess the evidence from rigorous clinical trials of the use of hawthorn extract to treat patients with chronic heart failure. We searched the literature using MEDLINE, EMBASE, the Cochrane Library, CINAHL, CISCOM, and AMED. Experts on and manufacturers of commercial preparations containing hawthorn extract were asked to contribute published and unpublished studies. There were no restrictions about the language of publication. Two reviewers independently performed the screening of studies, selection, validation, data extraction, and the assessment of methodological quality. To be included, studies were required to state that they were randomized, double-blind, and placebo controlled, and used hawthorn extract monopreparations. Thirteen trials met all inclusion criteria. In most of the studies, hawthorn was used as an adjunct to conventional treatment. Eight trials including 632 patients with chronic heart failure (New York Heart Association classes I to III) provided data that were suitable for meta-analysis. For the physiologic outcome of maximal workload, treatment with hawthorn extract was more beneficial than placebo (weighted mean difference, 7 Watt; 95% confidence interval [CI]: 3 to 11 Watt; P < 0.01; n = 310 patients). The pressure-heart rate product also showed a beneficial decrease (weighted mean difference, -20; 95% CI: -32 to -8; n = 264 patients) with hawthorn treatment. Symptoms such as dyspnea and fatigue improved significantly with hawthorn treatment as compared with placebo. Reported adverse events were infrequent, mild, and transient; they included nausea, dizziness, and cardiac and gastrointestinal complaints. In conclusion, these results suggest that there is a significant benefit from hawthorn extract as an adjunctive treatment for chronic heart failure.
这项荟萃分析的目的是评估来自使用山楂提取物治疗慢性心力衰竭患者的严格临床试验的证据。我们使用MEDLINE、EMBASE、Cochrane图书馆、CINAHL、CISCOM和AME进行文献检索。我们还向含有山楂提取物的商业制剂的专家和制造商索取已发表和未发表的研究。对发表语言没有限制。两名评审员独立进行研究筛选、选择、验证、数据提取和方法学质量评估。纳入的研究需声明为随机、双盲、安慰剂对照试验，并使用山楂提取物单一制剂。13项试验符合所有纳入标准。在大多数研究中，山楂被用作传统治疗的辅助药物。八项试验纳入了632例慢性心力衰竭（纽约心脏协会心功能分级I至III级）患者，提供了适合进行荟萃分析的数据。对于最大工作量这一生理指标，山楂提取物治疗比安慰剂更有益（加权平均差为7瓦特；95%置信区间[CI]：3至11瓦特；P<0.01；n=310例患者）。山楂治疗还使压力-心率乘积有显著下降（加权平均差为-20；95%CI：-32至-8；n=264例患者）。与安慰剂相比，山楂治疗能显著改善呼吸困难和疲劳等症状。报告的不良事件很少，且症状轻微、短暂，包括恶心、头晕以及心脏和胃肠道不适。总之，这些结果表明，山楂提取物作为慢性心力衰竭的辅助治疗有显著益处。
