中药防治蒽环类药物引发心律失常疗效的系统评价  

Efficacy of traditional Chinese medicine for arrhythmia caused by anthracycline drugs:a systematic review

作　　者：张琴[1] 杨欣宇[1] 张晓雨[1] 商洪才[1] ZHANG Qin;YANG Xinyu;ZHANG Xiaoyu;SHANG Hongcai(Kay Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, P.R.China)

机构地区：[1]北京中医药大学东直门医院中医内科学教育部和北京市重点实验室,北京100700

出　　处：《中国循证医学杂志》2018年第6期604-609,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金(编号:81430098)

摘　　要：目的系统评价中药防治蒽环类抗肿瘤药物引发心律失常的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI和WanFang Data数据库,搜集中药防治蒽环类抗肿瘤药物引发心律失常疗效的随机对照试验(RCT),检索时限均从建库至2017年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入4个RCT,包括312名患者。Meta分析结果显示:稳心颗粒治疗组心动过速发生率低于对照组[RR=0.35,95%CI(0.18,0.67),P=0.002]。保心康较抗氧化西药更有保护心肌SOD活性的作用[RR=2.25,95%CI(1.74,2.76),P<0.000 01],但两组房性早搏发生率[RR=0.40,95%CI(0.15,1.08),P=0.07]、室性早搏发生率[RR=0.56,95%CI(0.23,1.34),P=0.19]和心房颤动发生率[RR=0.41,95%CI(0.11,1.53),P=0.18]的差异无统计学意义。另外,稳心颗粒治疗的有效率与胺碘酮相比无显著差异;在化疗方案基础上加用稳心颗粒较单用化疗方案不能延缓疾病进展;乳腺癌蒽环类化疗引起心脏毒性患者采用稳心颗粒治疗,较单纯化疗及基础治疗不能改变SOD水平。结论当前研究显示稳心颗粒在预防和减少蒽环类药物引发心动过速发生方面可能有一定疗效,但在改善整体有效率、预防和减少房性早搏、室性早搏、心房颤动和SOD水平方面疗效不明确。保心康可能有保护心肌SOD活性的作用。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。ObjectivesTo systematically review the efficacy of traditional Chinese medicine for arrhythmia caused by anthracycline drugs.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data databases were electronically searched to collect randomized controlled trials （RCTs） on the efficacy of traditional Chinese medicine for arrhythmia caused by anthracycline drugs from inception to October 2017. Two reviewers independently screened literature, extracted data and evaluated risk of bias of included studies. Meta-analysis was then performed by Revman 5.3 software.ResultsA total of 4 RCTs involving 312 patients were included. The results of meta-analysis showed that： the incidence of tachycardia in the Wenxin granule treatment group was lower than that in the control group （RR=0.35, 95%CI 0.18 to 0.67, P=0.002）. Baoxinkang was more effective than antioxidant western medicine in protecting myocardial SOD activity （RR=2.25, 95%CI 1.74 to 2.76, P〈0.000 01）. But there was no significant difference between two groups on the incidence of atrial premature beats （RR=0.40, 95%CI 0.15 to 1.08,P=0.07）, premature ventricular contractions （RR=0.56, 95%CI 0.23 to 1.34, P=0.19） and atrial fibrillation （RR=0.41, 95%CI 0.11 to 1.53, P=0.18）. In addition, there was no significant difference between Wenxin granules and amiodarone in treating arrhythmia induced by anthracycline. The addition of Wenxin granules on the basis of anthracycline antitumor chemotherapy regimens was not effective in delaying disease progression compared with anthracycline alone. Wenxin granules could not change the SOD level of breast cancer patients with cardiotoxicity caused by anthracycline chemotherapy, compared with chemotherapy and basic treatment.ConclusionsThe current evidence shows that Wenxin granules can prevent and reduce anthracycline-induced tachycardia, but its efficacy in improving the overall efficiency, preventing and reducing atrial premature beats, premature ventricular contractions, atrial fibrillation, and

关 键 词：蒽环类抗肿瘤药物 中药 心律失常 系统评价 Meta分析 随机对照试验 

分 类 号：R541.7[医药卫生—心血管疾病]