伊布利特和胺碘酮治疗心房颤动和心房扑动的Meta分析

摘要

Objective To evaluate the efficacy and safety of ibutilide and amiodarone for treatment of atrial fibrillation ( AF ) and atrial flutter ( AFL ). Methods Randomized controlled trials ( RCT ) included written in Chinese and English concerning butilide and amiodarone in treatment of atrial fibrillation and atrial flutter were collected from 2007 to 2011 in a Meta analysis. The RevMan 5. 1 software of Cochrane Coordination Net was used for statistical analysis. Results There were nine papers reached the criteria enrolled in the study. ( 1 )Cardio-version rate of using ibutilide for treating AF ( 76. 60% ) was higher than that of amiodarone ( 57. 83% )( OR =2.38, 95% CI 1. 57 ~3. 59, P <0. 01 ). No bias was prompted on the funnel plot. ( 2 )Cardio-version rate of using ibutilide for treating AFL ( 80.00% ) was higher than that of amiodarone ( 28. 17% ) ( OR = 10. 18, 95% CI 4. 72 ~ 21. 96, P < 0. 01 ). ( 3 ) Total cardio-version rate of using ibutilide for treating AF/AFL (81.36% )was higher than that of amiodarone( 60. 91% )(OR = 2.82, 95% CI 1. 54 ~ 5. 15, P < 0. 01 ). ( 4 )The time for cardio-version of using ibutilide for treating AF/AFL was shorter than that of amiodarone( P <0. 01 ),the funnel plot suggested that publication bias might exist. ( 5 )An adverse reaction rate of ibutilide for treating AF/AFL was 20. 18% and amiodarone was 19. 29%( OR =0. 82, 95% CI 0. 37 ~ 1. 80, P =0. 62 ). No significant differences existed between the two medicines. The funnel plot suggested that publication bias might exist. Conclusion Compared with amiodarone, ibutilide is more effective for the treatment of atrial fibrillation and/or atrial flutter, but the safety of both medicines shows no significant difference.%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)的疗效及安全性.方法 通过计算机检索2007-2011年中英文电子文献数据库和手工检索的方式,收集有关伊布利特和胺碘酮治疗房颤和房扑的随机对照试验(RCT),应用RevMan 5.1软件进行Meta分析.结果 共纳入符合标准的RCT文献9篇.(1)房颤转复率:伊布利特(76.60%)高于胺碘酮(57.83%),其差异有统计学意义(OR=2.38,95%CI 1.57～3.59,P<0.01),漏斗图提示未见偏倚.(2)房扑转复率:伊布利特(80.00%)高于胺碘酮(28.17%),差异有统计学意义(OR=10.18,95%CI 4.72～21.96,P<0.01).(3)房颤/房扑总转复率:伊布利特(81.36%)高于胺碘酮(60.91%),差异有统计学意义(OR=2.82,95%CI 1.54～5.15,P<0.01).(4)转复时间:伊布利特组少于胺碘酮组,差异有统计学意义(P<0.01),漏斗图提示可能发生偏倚.(5)不良反应发生率:伊布利特组为20.18%,胺碘酮组为19.29%,差异无统计学意义(OR=0.82,95%CI 0.37～1.80,P=0.62).漏斗图提示可能发生偏倚.结论 与胺碘酮相比,伊布利特治疗心房颤动/心房扑动的转复率更高,安全性无明显差异.