目的 旨在评价现有文献中中药联合化疗药改善肿瘤患者化疗后心律失常的有效性及安全性，评估文献中是否存在多种偏倚因素，并对结局指标进行量化，为临床应用中药防治肿瘤患者化疗后心律失常提供可靠的证据支撑。方法 计算机检索PubMed、Cochrane Library、中国知网（CNKI）、万方等数据库，并辅以手工检索获得相关临床随机对照试验，检索时限均从建库至2023年5月。由2位评价员独立进行文献筛选、数据提取和研究质量评估。使用RevMan 5.4和Stata 17软件进行网状Meta分析。结果 共纳入16项临床随机对照试验，1380例肿瘤化疗后并发心律失常患者，11个中药处方（稳心颗粒、复方斑蝥、参麦注射液、参芪扶正注射液、参松养心胶囊、丹红注射液、生脉散、通络宁心汤、通脉四逆汤、心脉隆注射液和益心补气方）。传统Meta分析显示，与常规化疗药物相比，中药联合常规化疗药物可有效降低患者化疗后心律失常的发生率[OR＝0.31，95% CI （0.24，0.40），P<0.000 01]，减少心动过速、室性早搏、房性早搏发以及其他心律失常发生次数[OR＝0.40，95% CI （0.24，0.68），P＝0.000 8；OR＝0.37，95% CI （0.19，0.71），P＝0.003；OR＝0.41，95% CI （0.23，0.75），P＝0.004；OR＝0.21，95% CI （0.14，0.31），P<0.000 01]；可有效改善患者化疗后心功能，提高患者左心室射血分数（left ventricular ejection fraction，LVEF）、左室舒张末期内径（left ventricular end-diastolic dimension，LVEDD）值，改善患者肌钙蛋白T（cardiac troponin T，cTnT）、肌钙蛋白I（cardiac troponin I，cTnI）、肌酸激酶（creatine kinase-MB，CK-MB）[MD＝3.22，95% CI （0.92，5.52），P＝0.000 6；MD＝-0.03，95% CI （-0.06，-0.00），P＝0.03；MD＝-0.16，95% CI （-0.26，-0.06），P＝0.002；MD＝-5.10，95% CI （-8.06，-2.15），P＝0.000 7]。中药联合常规化疗药治疗后减少肿瘤患者心律失常发生率的网状Meta分析结果显示，稳心颗粒＋常规化疗［累积排序曲线下面积（surface under the cumulative ranking area，SUCRA）＝2.7%］<通络宁心汤＋常规化疗（SUCRA＝32.9%）<参芪扶正注射液＋常规化疗（SUCRA＝40.6%）<生脉散＋常规化疗（SUCRA＝41.4%）<参麦注射液＋常规化疗（SUCRA＝45.5%）<丹红注射液＋常规化疗（SUCRA＝49.7%）<益心补气方＋常规化疗（SUCRA＝52.2%）<参松养心胶囊＋常规化疗（SUCRA＝55.6%）<通脉四逆汤＋常规化疗（SUCRA＝85.5%）。结论 中药联合常规化疗可有效减少肿瘤患者化疗后心律失常的发生率，并改善患者心功能。而稳心颗粒联合常规化疗最有可能成为降低肿瘤患者化疗后新发心律失常的最佳干预措施。

Objective To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) and chemotherapeutic drugs to improve arrhythmia after chemotherapy in oncology patients and assess whether there are multiple bias factors in the literature and quantify the outcome indicators to provide reliable evidence to support the clinical application of TCMs for preventing and treating post-chemotherapy arrhythmia in cancer patients. Methods Randomized controlled trials (RCTs) of TCM in combination with conventional chemotherapy for post-chemotherapy arrhythmias were searched in PubMed, Cochrane Library, CNKI, and Wanfang databases from the inception to May 2023. Two evaluators independently performed article screening, data extraction, and study quality assessment. Data analysis was performed using RevMan 5.4 and Stata 17 software. Results A total of 16 RCTs with 1380 patients with arrhythmia complicated by tumor chemotherapy and 11 TCM prescriptions[Wenxin Granules (WXKL), Compound Cantharid (FFBM), Shenmai Injection (SMI), Shenqi Fuzheng Injection (SQFZ), Shensong Yangxin Capsules (SSYX), Danhong Injection (DHI), Shengmai Powder (SMS), Tongluo Ningxin Decoction (TLNX), Tongmai Sini Decoction (TMSN), Xinmailong Injection (XMLI), Yixin Buqi Prescription (YXBQ)] were included. Traditional Meta−analysis showed that TCM combined with conventional chemotherapy drugs could effectively reduce the incidence of post−chemotherapy arrhythmia [OR=0.31, 95%CI (0.24, 0.40), P < 0.000 01] and reduce the number of tachycardia, premature ventricular beats, premature atrial beats, and other arrhythmias compared with conventional chemotherapy drugs alone [(OR=0.40, 95% CI (0.24, 0.68), P=0.000 8); (OR=0.37, 95% CI (0.19, 0.71), P=0.003); (OR=0.41, 95% CI (0.23, 0.75), P=0.004); (OR=0.21, 95% CI (0.14, 0.31), P < 0.000 01)]. At the same time, TCM combined with conventional chemotherapy drugs can effectively improve patients' post−chemotherapy cardiac function, increase patients' EF values, improve pati(Maxim.) Kitag.] plastid was 160 521-160 555 bp, showing a typical tetrad structure. The GC contents of the chloroplast genome were 38.5%. The plastid genome contains 128 genes, including 85 protein-coding genes, 34 tRNA genes, and 8 rRNA genes. Furthermore, phylogenetic analysis indicated that topological trees recovered from the complete plastid genome and protein-coding datasets were consistent, suggesting that Asarum and Saruma species constitute a high support monophyletic clade. Conclusion Sequencing, assembly and structural analysis of Asari Radix et Rhizoma chloroplast genome in this study indicated that its size was between A. bracteolata and A. sieboldii var. seoulense, and rpl16, rps19, ycf1 and rpl23 genes were expanded in IR region. All research findings not only enriched the genetic resources of Asarum, but also provided a theoretical basis for the molecular identification, phylogeny, and protection, development and utilization of wild resources of this genus.

R285.64

商洪才-岐黄学者项目（2021）；国家自然科学基金项目（81725024）；中央高校基本科研业务费专项资金（2023-JYB-KYPT-01）