Pittler M H, Guo R, Ernst E
Cochrane Database Syst Rev. 2008 Jan 23;2008(1):CD005312. doi: 10.1002/14651858.CD005312.pub2.
Hawthorn extract is advocated as an oral treatment option for chronic heart failure. Also, the German Commission E approved the use of extracts of hawthorn leaf with flower in patients suffering from heart failure graded stage II according to the New York Heart Association.
To assess the benefits and harms as reported in double-blind randomised clinical trials of hawthorn extract compared with placebo for treating patients with chronic heart failure.
We searched CENTRAL on The Cochrane Library (issue 2, 2006), MEDLINE (1951 to June 2006), EMBASE (1974 to June 2006), CINAHL (1982 to June 2006) and AMED (1985 to June 2006). Experts and manufacturers were contacted. Language restrictions were not imposed.
To be included, studies were required to state that they were randomised, double-blind, and placebo controlled, and used hawthorn leaf and flower extract monopreparations.
Two reviewers independently performed the selection of studies, data extraction, and assessment of methodological quality. Data were entered into RevMan 4.2 software. Results from continuous data were reported as weighted mean difference (WMD) with 95% confidence interval (CI). Where data were suitable for combining, pooled results were calculated.
Fourteen trials met all inclusion criteria and were included in this review. In most of the studies, hawthorn was used as an adjunct to conventional treatment. Ten trials including 855 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 (WMD (Watt) 5.35, 95% CI 0.71 to 10.00, P < 0.02, n = 380). Exercise tolerance were significantly increased by hawthorn extract (WMD (Watt x min) 122.76, 95% CI 32.74 to 212.78, n = 98). The pressure-heart rate product, an index of cardiac oxygen consumption, also showed a beneficial decrease with hawthorn treatment (WMD (mmHg/min) -19.22, 95% CI -30.46 to -7.98, n = 264). Symptoms such as shortness of breath and fatigue improved significantly with hawthorn treatment as compared with placebo (WMD -5.47, 95% CI -8.68 to -2.26, n = 239). No data on relevant mortality and morbidity such as cardiac events were reported, apart from one trial, which reported deaths (three in active, one in control) without providing further details. Reported adverse events were infrequent, mild, and transient; they included nausea, dizziness, and cardiac and gastrointestinal complaints.
AUTHORS' CONCLUSIONS: These results suggest that there is a significant benefit in symptom control and physiologic outcomes from hawthorn extract as an adjunctive treatment for chronic heart failure.
山楂提取物被推荐作为慢性心力衰竭的一种口服治疗选择。此外，德国委员会E批准在纽约心脏协会分级为II级的心力衰竭患者中使用山楂叶花提取物。
评估在双盲随机临床试验中，与安慰剂相比，山楂提取物治疗慢性心力衰竭患者的益处和危害。
我们检索了Cochrane图书馆的CENTRAL（2006年第2期）、MEDLINE（1951年至2006年6月）、EMBASE（1974年至2006年6月）、CINAHL（1982年至2006年6月）和AMED（1985年至2006年6月）。并联系了专家和制造商。未设语言限制。
纳入的研究需声明为随机、双盲、安慰剂对照，且使用山楂叶花提取物单一制剂。
两名评价员独立进行研究选择、数据提取和方法学质量评估。数据录入RevMan 4.2软件。连续数据的结果以加权均数差（WMD）及95%置信区间（CI）报告。若数据适合合并，则计算合并结果。
14项试验符合所有纳入标准并纳入本综述。在大多数研究中，山楂被用作传统治疗的辅助手段。10项试验纳入了855例慢性心力衰竭（纽约心脏协会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学指标，山楂提取物治疗比安慰剂更有益（WMD（瓦特）5.35，95%CI 0.71至10.00，P<0.02，n = 380）。山楂提取物显著提高了运动耐量（WMD（瓦特×分钟）122.76，95%CI 32.74至212.78，n = 98）。作为心肌耗氧量指标的压力-心率乘积，在山楂治疗后也呈有益下降（WMD（毫米汞柱/分钟）-19.22，95%CI -30.46至-7.98，n = 264）。与安慰剂相比，山楂治疗使气短和疲劳等症状有显著改善（WMD -5.47，95%CI -8.68至-2.26，n = 239）。除一项试验报告了死亡情况（治疗组3例，对照组1例）但未提供更多细节外，未报告有关心脏事件等相关死亡率和发病率的数据。报告的不良事件不常见、轻微且短暂；包括恶心、头晕以及心脏和胃肠道不适。
这些结果表明，山楂提取物作为慢性心力衰竭的辅助治疗，在症状控制和生理学指标方面有显著益处。
