Zhang Juan, Cai Wen-Ke, Zhang Zheng, Wang Ping, Lin Xiao-Qian, Feng Ju, Fu Suo-Chao, He Gong-Hao
Research Center of Clinical Pharmacology, Yunnan Provincial Hospital of Traditional Chinese Medicine Department of Pharmacy Department of Cardio-Thoracic Surgery, Kunming General Hospital of PLA, Kunming Medical Engineering Section, the 306th Hospital of PLA, Beijing Department of Orthopaedics, Guangzhou General Hospital of PLA, Guangzhou, China.
Medicine (Baltimore). 2018 Apr;97(15):e0409. doi: 10.1097/MD.0000000000010409.
Histamine H2 antagonists (H2RAs) have long been suggested to have beneficial effects on congestive heart failure (CHF). However, full agreement about the cardioprotective effects of H2RAs is still not reached yet. Therefore, this study aims to clarify the effects of H2RAs on myocardial function in CHF patients by meta-analysis.
Electronic databases including PubMed, Embase, and Cochrane Library were retrieved. Randomized controlled trials comparing the cardiac effects of H2RAs and placebo or other medicines were collected. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated and meta-analysis was performed using RevMan 5.3 software.
A total of 10 studies (472 participants) were included in this meta-analysis. H2RAs exhibited significant negative inotropic and chronotropic effects to reduce heart rate (MD: -3.90; 95%CI: -7.07 to -0.73, P = .02). Furthermore, although H2RAs did not affect the blood pressure in health volunteers, they significantly decreased the blood pressure of CHF patients. Additionally, H2RAs were also associated with significant increase in pre-ejection period and the ratio of pre-ejection period to left ventricular ejection time.
In summary, these findings showed that H2RAs exerted negative inotropic and chronotropic effects to reduce heart rate and blood pressure, which, similar to beta-adrenergic receptor blockers, might decrease myocardial oxygen demand and eventually result in improvement of CHF symptoms. These data provided further evidence for the effect of H2RAs on cardiac function and novel potential strategy for treatment of CHF.
长期以来，一直有人认为组胺H2拮抗剂（H2RAs）对充血性心力衰竭（CHF）具有有益作用。然而，关于H2RAs的心脏保护作用尚未达成完全共识。因此，本研究旨在通过荟萃分析阐明H2RAs对CHF患者心肌功能的影响。
检索包括PubMed、Embase和Cochrane图书馆在内的电子数据库。收集比较H2RAs与安慰剂或其他药物心脏效应的随机对照试验。计算合并平均差（MDs）及其95%置信区间（CIs），并使用RevMan 5.3软件进行荟萃分析。
本荟萃分析共纳入10项研究（472名参与者）。H2RAs表现出显著的负性肌力和变时性作用，可降低心率（MD：-3.90；95%CI：-7.07至-0.73，P = 0.02）。此外，虽然H2RAs对健康志愿者的血压没有影响，但它们显著降低了CHF患者的血压。此外，H2RAs还与射血前期及射血前期与左心室射血时间比值的显著增加有关。
总之，这些研究结果表明，H2RAs发挥负性肌力和变时性作用以降低心率和血压，这与β-肾上腺素能受体阻滞剂类似，可能会降低心肌需氧量并最终改善CHF症状。这些数据为H2RAs对心脏功能的影响提供了进一步的证据，并为CHF治疗提供了新的潜在策略。
