Xin Yu, Dai Yan-Yan, Yang Hao-Xin, Zhang Xiu-Wen, Li Bo
Dongzhimen Hospital,Beijing University of Chinese Medicine Beijing 100700,China.
Beijing Institute of Traditional Chinese Medicine,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University Beijing 100010,China Yanqing Hospital,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University Beijing 102100,China.
Zhongguo Zhong Yao Za Zhi. 2019 Dec;44(23):5198-5206. doi: 10.19540/j.cnki.cjcmm.20190321.501.
This systematic review aims to evaluate the efficacy and safety of Wenxin Granules in the treatment of chronic heart failure with atrial fibrillation. Databases,such as CNKI,Wan Fang Date,VIP,PubMed,Cochrane Library,were electronically retrieved for relevant randomized controlled trials of Wenxin Granules in the treatment of chronic heart failure with atrial fibrillation. Two researchers independently screened out the literatures,extracted data according to the inclusion criteria,and conducted a quality assessment by the risk bias assessment tool in the Cochrane evaluation manual. Cochrane systematic evaluation software Rev Man 5. 3 was used for data analysis. Totally 11 randomized controlled trials,including 941 subjects. The intervention measures were the conventional treatment recommended by the guidelines combined with Wenxin Granules; and the control measures were the conventional treatment recommended by the guidelines alone. The results showed that compared with conventional treatment alone,Wenxin Granules combined with conventional treatment can better reduce the BNP level in patients with heart failure with atrial fibrillation( MD =-258. 18,95% CI[-464. 06,-52. 30],P= 0. 01) or NT-proBNP level,better improve left ventricular ejection fraction( MD = 6. 72,95%CI[4. 61,8. 84],P<0. 000 01),I2= 65%,And the ventricular rate decreased more significantly( MD =-11. 66,95% CI[-15. 79,-7. 54],P<0. 000 01),and the cardiac function was improved more efficiently( RR = 1. 20,95%CI [1. 11,1. 31],P<0. 000 1),I2= 23%.In conclusion,compared with the single administration of conventional Western medicine,the combined administration of Wenxin Granules has better effects in reducing the level of BNP or NT-proBNP,slowing down the ventricular rate,and improving the left ventricular ejection fraction,with fewer adverse reactions. However,due to the small sample size and the low quality of literatures included in this systematic review,it is shall be carefully applied in clinic. More rigorous randomized controlled trials shall be conducted to determine the efficacy of Wenxin Granules in improving cardiac function in the treatment of chronic heart failure with atrial fibrillation.
本系统评价旨在评估稳心颗粒治疗慢性心力衰竭合并心房颤动的疗效和安全性。通过电子检索中国知网、万方数据、维普、PubMed、Cochrane图书馆等数据库,查找稳心颗粒治疗慢性心力衰竭合并心房颤动的相关随机对照试验。由两名研究人员独立筛选文献,根据纳入标准提取数据,并采用Cochrane评价手册中的偏倚风险评估工具进行质量评估。使用Cochrane系统评价软件Rev Man 5.3进行数据分析。共纳入11项随机对照试验,包括941例受试者。干预措施为指南推荐的常规治疗联合稳心颗粒;对照措施为单纯指南推荐的常规治疗。结果显示,与单纯常规治疗相比,稳心颗粒联合常规治疗能更好地降低心房颤动合并心力衰竭患者的脑钠肽(BNP)水平(MD=-258.18,95%CI[-464.06,-52.30],P=0.01)或N末端脑钠肽前体(NT-proBNP)水平,更好地提高左心室射血分数(MD=6.72,95%CI[4.61,8.84],P<0.000 01),I²=65%,心室率下降更显著(MD=-11.66,95%CI[-15.79,-7.54],P<0.000 01),心功能改善更有效(RR=1.20,95%CI[1.11,1.31],P<0.000 1),I²=23%。综上所述,与单纯使用传统西药相比,稳心颗粒联合用药在降低BNP或NT-proBNP水平、减慢心室率、提高左心室射血分数方面效果更好,不良反应更少。然而,由于本系统评价纳入的样本量较小且文献质量较低,临床应用时应谨慎。需要进行更严格的随机对照试验,以确定稳心颗粒在治疗慢性心力衰竭合并心房颤动中改善心功能的疗效。