Vitamin C for preventing atrial fibrillation in high risk patients: a systematic review and meta-analysis.
Vitamin C for preventing atrial fibrillation in high risk patients: a systematic review and meta-analysis.
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DOI：
10.1186/s12872-017-0478-5
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发表时间：
2017-02-01
影响因子：
2.1
通讯作者：
Suonsyrjä T
中科院分区：
文献类型：
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作者：
Hemilä H;Suonsyrjä T
心房颤动(AF)是一种常见的心律失常，它与氧化应激有关，维生素C作为一种抗氧化剂可能对其产生影响。我们在Cochrane中央注册中心、MEDLINE和Scope us数据库中搜索了关于维生素C的随机试验，这些试验测量了房颤作为高危患者的结局。这两位作者独立地评估了纳入试验，评估了偏倚的风险，并提取了数据。我们使用Mantel-Haenszel方法合并选定的试验，计算风险比(RR)和逆方差加权计算对连续结果的影响。我们确定了15项关于高危患者预防房颤的试验，共有2050名受试者。14个试验检测了心脏手术患者术后房颤(POAF)，1个试验检测了心脏复律患者的房颤复发。五项试验在美国进行，五项在伊朗进行，三项在希腊进行，一项在斯洛文尼亚进行，一项在俄罗斯进行。维生素C预防房颤的作用具有明显的异质性。在美国进行的5项试验中，在RR = 为1.04(95%CI：0.86-1.27)的情况下，维生素C不能预防POAF。在美国以外的9个POAF试验中，在RR = 为0.56时，维生素C降低了该病的发病率(95%CI：0.47-0.67)。在希腊进行的单一心脏复律试验中，维生素C降低了房颤复发的风险，RR = 为0.13(95%CI：0.02-0.92)。在非美国心脏手术试验中，维生素C使住院时间减少了12.6%(95%可信区间为8.4-16.8%)，重症监护病房(ICU)住院时间减少了8.0%(95%可信区间为3.0-13.0%)。美国的试验没有发现对住院天数和重症监护室天数的影响。在15项试验中，没有维生素C的不良反应报道。我们的荟萃分析表明，在美国以外的一些国家，维生素C可以预防术后心房颤动，还可以缩短心脏手术患者的住院时间和ICU停留时间。维生素C是一种安全、廉价的基本营养素。需要进一步的研究来确定最佳的剂量方案，并确定受益最大的患者组。本文的在线版本(doi：10.1186/s12872-0170478-5)包含补充材料，授权用户可以使用。
Atrial fibrillation (AF), a common arrhythmia contributing substantially to cardiac morbidity, is associated with oxidative stress and, being an antioxidant, vitamin C might influence it. We searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for randomised trials on vitamin C that measured AF as an outcome in high risk patients. The two authors independently assessed the trials for inclusion, assessed the risk of bias, and extracted data. We pooled selected trials using the Mantel-Haenszel method for the risk ratio (RR) and the inverse variance weighting for the effects on continuous outcomes. We identified 15 trials about preventing AF in high-risk patients, with 2050 subjects. Fourteen trials examined post-operative AF (POAF) in cardiac surgery patients and one examined the recurrence of AF in cardioversion patients. Five trials were carried out in the USA, five in Iran, three in Greece, one in Slovenia and one in Russia. There was significant heterogeneity in the effect of vitamin C in preventing AF. In 5 trials carried out in the USA, vitamin C did not prevent POAF with RR = 1.04 (95% CI: 0.86–1.27). In nine POAF trials conducted outside of the USA, vitamin C decreased its incidence with RR = 0.56 (95% CI: 0.47–0.67). In the single cardioversion trial carried out in Greece, vitamin C decreased the risk of AF recurrence by RR = 0.13 (95% CI: 0.02–0.92). In the non-US cardiac surgery trials, vitamin C decreased the length of hospital stay by 12.6% (95% CI 8.4–16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI 3.0–13.0%). The US trials found no effect on hospital stay and ICU stay. No adverse effects from vitamin C were reported in the 15 trials. Our meta-analysis indicates that vitamin C may prevent post-operative atrial fibrillation in some countries outside of the USA, and it may also shorten the duration of hospital stay and ICU stay of cardiac surgery patients. Vitamin C is an essential nutrient that is safe and inexpensive. Further research is needed to determine the optimal dosage protocol and to identify the patient groups that benefit the most. The online version of this article (doi:10.1186/s12872-017-0478-5) contains supplementary material, which is available to authorized users.