半夏白术天麻汤联合降压药治疗原发性高血压有效性的Meta分析

Systematic Review and Meta-Analysis of the Efficacy of Banxia Baizhu Tianma Decoction(半夏白术天麻汤)Combined with Antihypertensive Drugs in the Treatment of Essential Hypertension

目的:评价半夏白术天麻汤联合降压药治疗原发性高血压有效性。方法:计算机检索相关数据库中关于半夏白术天麻汤联合西药治疗原发性高血压的临床随机对照试验,根据Corchrane协作网提供的风险评估工具对文献进行质量评价,数据使用Stata12.0软件进行统计分析。结果:共纳入30篇RCT,共计2389例患者。治疗组的常规治疗联合半夏白术天麻汤在血压水平变化(收缩压MD=-7.71,95%CI[-8.62,-6.80],舒张压WMD=-6.75,95%CI[-7.58,-5.92]),降压疗效(RR=1.18,95%CI[1.12,1.24]),中医证候疗效(RR=1.28,95%CI[1.17,1.40]),同型半胱氨酸(WMD=-4.04[-5.60,-2.49]),血清指标(AngⅡ:WMD=-14.95,95%CI[-18.58,-11.33],PRA:WMD=-0.55,95%CI[-0.81,-0.29],ALD:WMD=-28.64,95%CI[-33.17,-24.11]),血脂指标(TC:WMD=-0.45,95%CI[-0.64,-0.26],TG:WMD=-0.44,95%CI[-0.68,-0.20],HDL-C:WMD=0.29,95%CI[0.15,0.42],LDL-C:WMD=-0.40,95%CI[-0.50,-0.29])方面治疗效果均优于单纯使用降压药,差异均具有统计学意义(P<0.01)。共有16篇文献报道了不良反应,9篇无不良反应,4篇数据无效,2篇经统计(RR=0.43,95%CI[0.25,0.73]),差异有统计学意义(P<0.01)。结论:常规治疗联合半夏白术天麻汤,在治疗原发性高血压以及Hcy、血清指标、血脂指标的改善和安全性方面,均优于单纯使用降压药。但本研究纳入文献均未提及使用盲法和分配隐藏,缺乏大数据支持,以及干预方式内容不统一等,需要进一步探索改进。

Objective:To evaluate the efficacy of Banxia Baizhu Tianma Decoction(半夏白术天麻汤)combined with antihypertensive drugs in the treatment of essential hypertension.Methods:Randomized controlled trials(RCTs)on the treatment of essential hypertension with Banxia Baizhu Tianma Decoction and antihypertensive western medicine were retrieved in related databases.Cochrane Collaboration’s tool was employed to evaluate the quality of the eligible RCTs.Then Stata12.0 was used for data analysis.Results:A total of 30 RCTs were included,involving 2389 patients.The conventional treatment combined with Banxia Baizhu Tianma Decoction in the treatment group was superior to antihypertensive drugs alone in terms of blood pressure variation(systolic blood pressure MD=-7.71,95%CI[-8.62,-6.80]),diastolic blood pressure WMD=-6.75,95%CI[-7.58,-5.92],antihypertensive effect(RR=1.18,95%CI[1.12,1.24]),traditional Chinese medicine(TCM)syndrome score(RR=1.28,95%CI[1.17,1.40]),homocysteine(WMD=-4.04[-5.60,-2.49]),serum indexes(AngⅡ:WMD=-14.95,95%CI[-18.58,-11.33],PRA:WMD=-0.55,95%CI[-0.81,-0.29],ALD:WMD=-28.64,95%CI[-33.17,-24.11]),and lipid indexes(TC:WMD=-0.45,95%CI[-0.64,-0.26],TG:WMD=-0.44,95%CI[-0.68,-0.20],HDL-C:WMD=0.29,95%CI[0.15,0.42],LDL-C:WMD=-0.40,95%CI[-0.50,-0.29])(P<0.01).A total of 16 articles mentioned the adverse reactions:no adverse reactions in 9 articles,invalid data in 4,and statistically significant difference in 2(RR=0.43,95%CI[0.25,0.73])(P<0.01).Conclusion:Conventional treatment combined with Banxia Baizhu Tianma Decoction is superior to the antihypertensive drugs in the treatment of essential hypertension and the improvement of Hcy,serum indexes,and blood lipid indexes.However,none of the articles included in this study mentioned the use of blind method and allocation concealment.Moreover,with the lack of big data support and inconsistent content of intervention methods,the conclusion of this study should be further verified.