学术论文

      伊布利特与胺碘酮治疗心房颤动和心房扑动有效性与安全性的Meta分析

      Efficacy and safety of ibutilide and amiodarone in treatment of atrial fibrillation and atrial flutter:A Meta-analysis

      摘要:
      目的:系统评价伊布利特与胺碘酮治疗心房颤动(房颤)和心房扑动(房扑)有效性与安全性。方法检索中国生物医学文献数据库(1978~2014.4)、中国期刊全文数据库(1994~2014.4)、维普数据库(1999~2014.4)、万方数据库(1990~2014.4)、PubMed(1990~2014.4)、Cochrane Library(2014第4期)。纳入伊布利特(实验组)与胺碘酮(对照组)比较治疗房颤和房扑的随机对照试验(RCTs),由两位研究员独立筛选并提取资料,采用Cochrane5.1手册推荐的简单评估法进行纳入研究质量评价,采用RevMan5.2进行Meta分析。结果共检索到文献489篇,按照纳入和排除标准,最终纳入25篇进行Meta分析。Meta分析结果:①伊布利特转复房颤/房扑的总有效率高于胺碘酮(OR=3.26,95%CI:2.60~4.08,P<0.00001);②伊布利特转复房颤的有效率高于胺碘酮(OR=2.71,95%CI:2.04~3.58,P<0.00001);③伊布利特转复房扑的有效率高于胺碘酮(OR=7.05,95%CI:4.13~12.04,P<0.00001);④伊布利特转复房颤/房扑平均转复时间短于胺碘酮(WMD=-67.16 min,95%CI:-87.27~-47.04,P<0.00001);⑤伊布利特与胺碘酮总不良反应发生率无明显差别(OR=1.02,95%CI:0.72~1.43,P=0.93)。结论目前研究显示,伊布利特治疗房颤和房扑的有效性高于胺碘酮,且平均转复时间短于胺碘酮,在安全性方面二者无显著差异。由于纳入研究数量及质量有限,该结论尚需大样本、高质量的随机对照试验进一步证实。
      Abstract:
      Objective To review systematically the efficacy and safety of ibutilide and amiodarone in treatment of atrial fibrillation (AF) and atrial flutter (AFL).Methods The databases of CBM (1978-2014.4), CNKI (1994-2014.4), VIP Database (1999-2014.4), WanFang Database (1990~2014.4), PubMed (1990-2014.4), and Cochrane Library (4th issue of 2014) were retrieved for collecting randomized controlled trials (RCT) about comparison between ibutilide (test group) and amiodarone (control group) in treatment of AF and AFL. The data was screened and extracted by 2 researchers independently, and then the quality of the RCT was reviewed by applying homeostasis assessment recommended in Cochrane5.1 handbook and treated by using RevMan5.2 software.Results There were totally 489 RCT included, and finally there were 25 enclosed into Meta-analysis according to inclusion and exclusion criteria. The results of Meta-analysis showed: ①The total effective rate in alleviating AF/AFL was higher in test group than that in control group (OR=3.26, 95%CI: 2.60-4.08,P<0.00001). ②The total effective rate in alleviating AF was higher in test group than that in control group (OR=2.71, 95%CI: 2.04-3.58,P<0.00001). ③The total effective rate in alleviating AFL was higher in test group than that in control group (OR=7.05, 95%CI:4.13-12.04,P<0.00001). ④The average time in alleviating AF/AFL was shorter in test group than that in control group (WMD=-67.16 min, 95%CI: -87.27- -47.04,P<0.00001). ⑤The total incidence of adverse reactions had no significant difference between 2 groups (OR=1.02, 95%CI: 0.72-1.43,P=0.93).Conclusion The current studies show that ibutilide has higher efficacy and shorter average alleviating time compared with amiodarone in treatment of AF and AFL, and they have no difference in safety. As this analysis has limited quantity and quality in RCT, more large-sample RCT with higher quality are required for further identifying the results.
      Author: TONG Sui-yang XIA Hao WANG Xin LI Lei WANG Hui
      作者单位: 武汉大学人民医院心内科, 武汉,430060
      年,卷(期): 2014, (6)
      分类号: R541.75
      机标分类号: R65 R54
      在线出版日期: 2015年1月23日
      基金项目: 国家自然科学基金