地尔硫卓与西地兰控制房颤心室率比较的Meta分析  

Meta-analysis of Diltiazem and Cedilanid for the control of rapid ventricular rate in atrial fibrillation

作　　者：黄燕[1] 黄从新[1] 

机构地区：[1]武汉大学人民医院心内科,湖北武汉430060

出　　处：《中国医药导报》2014年第25期86-90,共5页China Medical Herald

摘　　要：目的比较地尔硫卓与西地兰两种药物对房颤心室率控制的有效性和安全性。方法计算机检索PubMed、CENTRAL、EMbase、MEDLINE、CBMdisc、CNKI、CBM和万方数据库,查找所有比较地尔硫卓与西地兰控制房颤心室率的随机对照试验(RCT),检索时间均为建库至2014年2月10日。同时手检纳入文献的参考文献。按纳入排除标准进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析,并采用GRADE系统进行证据质量评价。结果共纳入8个研究,共474例患者。Meta分析结果显示:1在有效性方面:与西地兰相比,地尔硫卓控制房颤心室率总有效率较高[RR=1.27,95%CI(1.14,1.41),P<0.0001];房颤心室率下降幅度差异无统计学意义[SMD=1.06,95%CI(-0.44,2.56),P=0.17>0.05];平均起效时间较短[SMD=-4.54,95%CI(-6.77,-2.30),P<0.0001];复律率差异无统计学意义[RR=1.28,95%CI(0.37,4.42),P=0.69>0.05]。2在安全性方面:地尔硫卓组与西地兰组发生低血压率差异无统计学意义[RR=3.81,95%CI(0.98,14.74),P=0.05]。基于系统评价结果,采用GRADE系统推荐分级方法评价证据质量,结果显示,证据水平均为中级。结论地尔硫卓与西地兰相比,有效性更高,安全性与西地兰无差别,但因原始研究的质量均不高,需要更多高质量、大样本的RCT进一步论证。Objective To evaluate the efficacy and safety of Diltiazem and Cedilanid for the control of rapid ventricular rate in atrial fibrillation. Methods Such databases as PubMed, CENTRAL, EMbase, MEDLINE, CBMdisc, CNKI, CBM and Wanfang were searched from their establishment to February 2014 for collecting the randomized controlled trials （RCTs） about Diltiazem vs Cedilanid for the control of rapid ventricular rate in atrial fibrillation. And the references of those RCTs were also researched by hand. After study selection, assessment and date extraction, Meta-analysis were performed by using the RevMan 5.2 software. The level of evidences were assessed by using the GRADE system. Re-sults 8 studies involving 474 patients were included. The results of Meta-analysis showed that： ①efficacy indicator：compared with Cedilanid, Diltiazem had a higher effective rate [RR = 1.27, 95%CI （1.14, 1.41）, P〈 0.0001], a shorter onset time [SMD = -4.54, 95%CI （-6.77, -2.30）, P〈 0.0001], but there was no significant difference between the two groups in the fall range of ventricular rate [SMD= 1.06, 95%CI （-0.44, 2.56）, P= 0.17＆gt;0.05] and cardioversion rate [RR = 1.28, 95%CI （0.37, 4.42）, P= 0.69＆gt;0.05]. ②safety indicator： there was no significant difference between the two groups in occurring hypotension [RR =3.81, 95%CI （0.98,14.74）, P=0.05]. Based on GRADE system, all the ev-idences were not at a high level. Conclusion Compared with Cedilanid, Diltiazem has a higher effectiveness, and has no significant difference from Cedilanid in safety. For the poor quality of the original studies, more high-quality, large-sample studies are needed.

关 键 词：心房颤动 心室率 地尔硫卓 西地兰 META分析 系统评价 随机对照试验 

分 类 号：R541.75[医药卫生—心血管疾病]