Zheng Rui, Tian Guihua, Zhang Qin, Wu Lin, Xing Yanwei, Shang Hongcai
Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Beijing University of Chinese Medicine, Beijing, China.
Front Physiol. 2018 May 23;9:487. doi: 10.3389/fphys.2018.00487. eCollection 2018.
To evaluate possible adverse effects and efficacy of Wenxin keli (WXKL)-amiodarone combination on heart failure complicated by ventricular arrhythmia. Nine electronic literature databases (the Cochrane Library, PubMed, EMBASE, IPA, AMED, CBM, CNKI, VIP, and WanFang) were searched up to February 2018. Two authors extracted data and assessed risk of bias of the included studies independently. Randomized controlled trials (RCTs) and quasi-RCTs about WXKL-amiodarone combination and amiodarone alone were eligible for comparison. Thirteen trials involving 1,126 patients were included. Risk of bias was assessed as high in three studies and unclear in the remaining 10 studies. Six trials reported adverse events (AE). There was no obvious difference between WXKL-amiodarone combination group and amiodarone group in reported AEs (OR 0.64; 95%CI 0.39-1.07). The total effective rate of WXKL-amiodarone combination group was greater than that of amiodarone group (RR 1.22; 95%CI 1.16-1.29). The pooled results showed that the combination group was more effective in reducing heart rate (MD -2.25; 95%CI -2.61 to -1.88, = 0.46, = 0%), the frequency of ventricular premature complexes (MD -2.03; 95%CI -2.41 to -1.65) and QT dispersion (MD 5.59; 95%CI 3.60-7.58). The WXKL-amiodarone combination is safe and shows more protective effects on heart failure combined with ventricular arrhythmia compared with amiodarone alone. Further research is warranted, ideally involving large, prospective, rigorous trials, in order to confirm these findings.
评估稳心颗粒(WXKL)联合胺碘酮治疗心力衰竭合并室性心律失常的可能不良反应及疗效。检索了截至2018年2月的九个电子文献数据库(考克兰图书馆、PubMed、EMBASE、IPA、AMED、中国生物医学文献数据库、中国知网、维普资讯和万方数据)。两名作者独立提取数据并评估纳入研究的偏倚风险。关于WXKL联合胺碘酮及单纯胺碘酮的随机对照试验(RCT)和半随机对照试验符合比较条件。纳入了13项涉及1126例患者的试验。3项研究的偏倚风险评估为高,其余10项研究的偏倚风险不明确。6项试验报告了不良事件(AE)。在报告的不良事件方面,WXKL联合胺碘酮组与胺碘酮组之间无明显差异(比值比0.64;95%置信区间0.39 - 1.07)。WXKL联合胺碘酮组的总有效率高于胺碘酮组(相对危险度1.22;95%置信区间1.16 - 1.29)。汇总结果显示,联合组在降低心率(平均差 -2.25;95%置信区间 -2.61至 -1.88,I² = 0.46,P = 0%)、室性早搏频率(平均差 -2.03;95%置信区间 -2.41至 -1.65)和QT离散度(平均差5.59;95%置信区间3.60 - 7.58)方面更有效。与单纯胺碘酮相比,WXKL联合胺碘酮治疗心力衰竭合并室性心律失常安全且显示出更多保护作用。有必要进行进一步研究,理想情况下涉及大型、前瞻性、严谨的试验,以证实这些发现。