胺碘酮与普罗帕酮治疗心房颤动的Meta分析

目的评价国内用胺碘酮与普罗帕酮治疗心房颤动的疗效。方法计算机检索1998～2006年中国期刊网数据库。应用Cochrane协作网提供的RevMan4.2软件系统评价,对胺碘酮(胺碘酮组)与普罗帕酮(普罗帕酮组)治疗心房颤动疗效的随机对照试验进行Meta分析。结果(1)静脉注射胺碘酮与普罗帕酮治疗快速心房颤动的合并检验分析,综合检验结果为:Z=3.44,P=0.000,OR=1.68,95%CI:1.25～2.26,漏斗图分析结果未发现显著偏倚;(2)口服胺碘酮与普罗帕酮预防心房颤动复发的合并检验分析,综合检验结果为:Z=2.51,P=0.010,OR=1.49,95%CI:1.09～2.03,漏斗图分析结果提示可能存在发表偏倚;(3)两组不良反应发生率的比较综合检验结果:OR=0.85,95%CI:0.62～1.16,漏斗图分析结果未发现显著偏倚。结论胺碘酮组治疗心房颤动的总有效率高于普罗帕酮组;目前国内在治疗心房颤动的临床试验中,设计仍不够严谨。

A meta-analysis of amiodarone and propafenone treatment of atrial fibrillation

Objective To evaluate the therapeutic effectiveness of amiodarone and propafenone in treatment of atrial fibrillation.Methods According to the method provided by the international Cochrane Coordination Net,the randomized controlled trials(RCTs)concerning the amiodarone and propafenone in treatment of atrial fibrillation were subjected to a meta-analysis.An electronic search of Chinese National Knowledge Infrastructure(CNKI)(1998-2006)was carried out to include the data into RCTs for the comparison between amiodarone and propafenone.The Rev Man 4.2 software of Cochrane Coordination Net was used for statistical analysis.Results The significant difference between pooled efficacy rates of intravenons amiodarone and propafenone in patients with rapid atrial fibrillation was Z=3.44,P=0.000,combined OR=1.68(95%CI:1.25 to 2.26).No significant publication bias was found.Significant difference in preventing atrial fibrillation between oral administration of the two drugs was found(Z=2.51,P=0.010).The funnel plot suggested that publication bias might exist.Meta-analysis of adverse reactions of the two drugs indicated that OR was 0.85(95%CI:0.62 to 1.16).Conclusion Compared with propafenone,amiodarone has enhanced total efficacy;but the designs of the studies reported in China are not rigorous enough.