Abstract：
Viral myocarditis (VMC) is a life-threatening disease that can affect all ages and genders, with middle-aged adults being particularly susceptible. Numerous systematic reviews have been conducted to investigate the efficacy and safety of Chinese herbal medicine (CHM) in treating adult viral myocarditis (AVM). The objective of this study was to conduct a comprehensive overview of systematic reviews and meta-analyses of randomized controlled trials (RCTs) regarding the efficacy and safety of CHM for AVM.
A comprehensive systematic search was conducted across 8 electronic databases from their inception to June 23, 2022, augmented by manual searches of the gray literature. Systematic reviews were independently selected and data extracted in accordance with predetermined criteria by 2 reviewers. Included systematic reviews were assessed for methodologic and reporting quality using Assessing the Methodological Quality of Systematic Reviews 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The quality of evidence relating to outcome measures was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Recalculation of effect sizes and subsequent determination of 95% CIs were conducted with either a fixed-effects or random-effects model.
The current overview of systematic reviews included a total of 6 systematic reviews, which reported on 67 RCTs with a participant pool of 5611 individuals. The findings of our study indicate that the combination of CHM and Western medications had positive effects on the effective rate, cure rate, ECG recovery, atrial premature contraction/premature ventricular contraction, left ventricular ejection fraction, myocardial enzymes, and improvement of clinical symptoms for AVM. The adverse drug reactions in the combination therapy group were generally less than or lighter than that in the Western medication group (relative risk = 0.79; 95% CI, 0.44-1.40; P > 0.05, I2 = 0).
Our research results provide evidence that combining CHM with Western medicine could offer potential benefits for patients with AVM. However, the number of studies included in our review is limited and the methodologic quality of these studies is modest. Therefore, there are potential uncertainties regarding the conclusion that CHM with Western medication may benefit patients with AVM. We call for more large-scale, high-quality studies with standardized designs to further verify and support our findings. This would promote a better understanding of the efficacy and safety profile of CHM and provide reliable reference evidence for clinical practice and policy making. Moreover, future research should explore optimal drug combinations, examine therapeutic doses and durations of CHM combination therapy, and evaluate its long-term efficacy and safety.
A comprehensive systematic search was conducted across 8 electronic databases from their inception to June 23, 2022, augmented by manual searches of the gray literature. Systematic reviews were independently selected and data extracted in accordance with predetermined criteria by 2 reviewers. Included systematic reviews were assessed for methodologic and reporting quality using Assessing the Methodological Quality of Systematic Reviews 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The quality of evidence relating to outcome measures was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Recalculation of effect sizes and subsequent determination of 95% CIs were conducted with either a fixed-effects or random-effects model.
The current overview of systematic reviews included a total of 6 systematic reviews, which reported on 67 RCTs with a participant pool of 5611 individuals. The findings of our study indicate that the combination of CHM and Western medications had positive effects on the effective rate, cure rate, ECG recovery, atrial premature contraction/premature ventricular contraction, left ventricular ejection fraction, myocardial enzymes, and improvement of clinical symptoms for AVM. The adverse drug reactions in the combination therapy group were generally less than or lighter than that in the Western medication group (relative risk = 0.79; 95% CI, 0.44-1.40; P > 0.05, I2 = 0).
Our research results provide evidence that combining CHM with Western medicine could offer potential benefits for patients with AVM. However, the number of studies included in our review is limited and the methodologic quality of these studies is modest. Therefore, there are potential uncertainties regarding the conclusion that CHM with Western medication may benefit patients with AVM. We call for more large-scale, high-quality studies with standardized designs to further verify and support our findings. This would promote a better understanding of the efficacy and safety profile of CHM and provide reliable reference evidence for clinical practice and policy making. Moreover, future research should explore optimal drug combinations, examine therapeutic doses and durations of CHM combination therapy, and evaluate its long-term efficacy and safety.
摘要：
目的：病毒性心肌炎（VMC）是一种威胁生命的疾病，可影响所有年龄和性别，中年人特别容易受到影响。已进行了许多系统评价以研究中草药（CHM）治疗成人病毒性心肌炎（AVM）的疗效和安全性。这项研究的目的是对关于CHM治疗AVM的有效性和安全性的随机对照试验（RCTs）的系统评价和荟萃分析进行全面概述。
方法：从成立到2022年6月23日，对8个电子数据库进行了全面的系统搜索，并通过手动搜索灰色文献进行了扩展。由2名评审员独立选择系统评价并根据预定标准提取数据。使用评估系统评价2的方法学质量和系统评价和荟萃分析的首选报告项目评估纳入的系统评价的方法学和报告质量。与结果测量相关的证据质量使用建议分级进行评估，评估,发展,和评估工具。使用固定效应或随机效应模型进行效应大小的重新计算并随后确定95％CI。
结果：当前对系统综述的概述共包括6项系统综述，该研究报告了67项RCT，参与者为5611人。我们的研究结果表明，CHM和西药的组合对有效率有积极的影响，治愈率,心电图恢复,房性早搏/室性早搏,左心室射血分数,心肌酶，改善AVM的临床症状。联合治疗组的药物不良反应普遍少于或轻于西药组（相对危险度=0.79；95%CI，0.44～1.40；P>0.05，I2=0）。
结论：我们的研究结果提供了证据，表明CHM与西药联合治疗可以为AVM患者提供潜在的益处。然而,纳入我们综述的研究数量有限,这些研究的方法学质量不大.因此,关于CHM联合西药治疗可能使AVM患者受益的结论存在潜在的不确定性.我们呼吁更大规模，采用标准化设计的高质量研究，以进一步验证和支持我们的发现。这将有助于更好地了解CHM的疗效和安全性，并为临床实践和政策制定提供可靠的参考证据。此外，未来的研究应该探索最佳的药物组合，检查CHM联合治疗的治疗剂量和持续时间，并评价其长期疗效和安全性。
方法：从成立到2022年6月23日，对8个电子数据库进行了全面的系统搜索，并通过手动搜索灰色文献进行了扩展。由2名评审员独立选择系统评价并根据预定标准提取数据。使用评估系统评价2的方法学质量和系统评价和荟萃分析的首选报告项目评估纳入的系统评价的方法学和报告质量。与结果测量相关的证据质量使用建议分级进行评估，评估,发展,和评估工具。使用固定效应或随机效应模型进行效应大小的重新计算并随后确定95％CI。
结果：当前对系统综述的概述共包括6项系统综述，该研究报告了67项RCT，参与者为5611人。我们的研究结果表明，CHM和西药的组合对有效率有积极的影响，治愈率,心电图恢复,房性早搏/室性早搏,左心室射血分数,心肌酶，改善AVM的临床症状。联合治疗组的药物不良反应普遍少于或轻于西药组（相对危险度=0.79；95%CI，0.44～1.40；P>0.05，I2=0）。
结论：我们的研究结果提供了证据，表明CHM与西药联合治疗可以为AVM患者提供潜在的益处。然而,纳入我们综述的研究数量有限,这些研究的方法学质量不大.因此,关于CHM联合西药治疗可能使AVM患者受益的结论存在潜在的不确定性.我们呼吁更大规模，采用标准化设计的高质量研究，以进一步验证和支持我们的发现。这将有助于更好地了解CHM的疗效和安全性，并为临床实践和政策制定提供可靠的参考证据。此外，未来的研究应该探索最佳的药物组合，检查CHM联合治疗的治疗剂量和持续时间，并评价其长期疗效和安全性。
