Department of Cardiovascular, Guang 'anmen Hospital of The Chinese Academy of Chinese Medical Sciences, Beijing, China.
Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China.
Clin Ther. 2023 Oct;45(10):991-1003. doi: 10.1016/j.clinthera.2023.08.005. Epub 2023 Sep 9.
Viral myocarditis (VMC) is a life-threatening disease that can affect all ages and genders, with middle-aged adults being particularly susceptible. Numerous systematic reviews have been conducted to investigate the efficacy and safety of Chinese herbal medicine (CHM) in treating adult viral myocarditis (AVM). The objective of this study was to conduct a comprehensive overview of systematic reviews and meta-analyses of randomized controlled trials (RCTs) regarding the efficacy and safety of CHM for AVM.
A comprehensive systematic search was conducted across 8 electronic databases from their inception to June 23, 2022, augmented by manual searches of the gray literature. Systematic reviews were independently selected and data extracted in accordance with predetermined criteria by 2 reviewers. Included systematic reviews were assessed for methodologic and reporting quality using Assessing the Methodological Quality of Systematic Reviews 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The quality of evidence relating to outcome measures was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Recalculation of effect sizes and subsequent determination of 95% CIs were conducted with either a fixed-effects or random-effects model.
The current overview of systematic reviews included a total of 6 systematic reviews, which reported on 67 RCTs with a participant pool of 5611 individuals. The findings of our study indicate that the combination of CHM and Western medications had positive effects on the effective rate, cure rate, ECG recovery, atrial premature contraction/premature ventricular contraction, left ventricular ejection fraction, myocardial enzymes, and improvement of clinical symptoms for AVM. The adverse drug reactions in the combination therapy group were generally less than or lighter than that in the Western medication group (relative risk = 0.79; 95% CI, 0.44-1.40; P > 0.05, I = 0).
Our research results provide evidence that combining CHM with Western medicine could offer potential benefits for patients with AVM. However, the number of studies included in our review is limited and the methodologic quality of these studies is modest. Therefore, there are potential uncertainties regarding the conclusion that CHM with Western medication may benefit patients with AVM. We call for more large-scale, high-quality studies with standardized designs to further verify and support our findings. This would promote a better understanding of the efficacy and safety profile of CHM and provide reliable reference evidence for clinical practice and policy making. Moreover, future research should explore optimal drug combinations, examine therapeutic doses and durations of CHM combination therapy, and evaluate its long-term efficacy and safety.
病毒性心肌炎（VMC）是一种危及生命的疾病，可影响所有年龄和性别，中年成年人尤其易受影响。已经进行了许多系统评价来研究中药（CHM）治疗成人病毒性心肌炎（AVM）的疗效和安全性。本研究的目的是对 CHM 治疗 AVM 的疗效和安全性的随机对照试验（RCT）的系统评价和荟萃分析进行全面综述。
从成立到 2022 年 6 月 23 日，我们全面系统地搜索了 8 个电子数据库，并通过手动搜索灰色文献进行了补充。由 2 名审查员独立选择和提取符合预定标准的数据。使用评估系统评价方法学和报告质量 2 版和系统评价和荟萃分析的首选报告项目对纳入的系统评价进行方法学和报告质量评估。使用推荐分级评估、制定与评价工具评估与结局测量相关的证据质量。使用固定效应或随机效应模型计算效应大小的重新计算，并随后确定 95%置信区间。
目前的系统综述综述包括 6 项系统评价，这些系统评价报告了 67 项 RCT，共有 5611 名参与者。我们的研究结果表明，CHM 与西药联合使用对 AVM 的有效率、治愈率、心电图恢复、房性早搏/室性早搏、左心室射血分数、心肌酶和临床症状改善均有积极影响。联合治疗组的药物不良反应一般轻于或少于西药组（相对风险=0.79；95%CI，0.44-1.40；P>0.05，I=0）。
我们的研究结果提供了证据表明，将 CHM 与西药联合使用可能对 AVM 患者有益。然而，我们综述中包含的研究数量有限，这些研究的方法学质量也不高。因此，关于 CHM 联合西药可能有益于 AVM 患者的结论存在潜在的不确定性。我们呼吁开展更多具有标准化设计的大规模、高质量研究，以进一步验证和支持我们的研究结果。这将促进对 CHM 疗效和安全性的更好理解，并为临床实践和决策提供可靠的参考证据。此外，未来的研究应探索最佳药物组合，检查 CHM 联合治疗的治疗剂量和持续时间，并评估其长期疗效和安全性。
