口服中成药联合美托洛尔治疗冠心病室性期前收缩有效性及安全性的网状Meta分析

Network Meta-analysis of Effectiveness and Safety of Oral Chinese Patent Medicine Combined with Metoprolol in Treating Ventricular Premature Contraction of Coronary Heart Disease

目的利用网状Meta分析,对口服中成药联合美托洛尔治疗冠心病室性期前收缩的有效性及安全性进行评估。方法互联网检索中国知网、万方数据知识服务平台、维普、PubMed、EMbase、考克兰数据库中口服中成药治疗冠心病室性期前收缩的随机对照试验。依据Cochrane手册中的偏倚风险评估方法对纳入文献进行质量评估,使用GeMTC软件、Stata13.0进行分析。结果纳入33个随机对照试验,涉及5种口服中成药,研究患者总量为3898例。网状Meta分析结果显示,在治疗有效率方面,参松养心胶囊联合美托洛尔成为最优治疗方案的可能最大,其次为稳心颗粒联合美托洛尔;改善24 h动态心电图结果方面,参松养心胶囊联合美托洛尔成为最优治疗方案可能性最大,其次为稳心颗粒联合美托洛尔;改善EF值方面,稳心颗粒联合美托洛尔成为最优治疗方案可能性最大,其次为脑心通胶囊联合美托洛尔;不良反应结果显示各治疗方案间未见明显差异。结论口服中成药联合美托洛尔可提高冠心病室性期前收缩的临床疗效,且安全性较好,但受到研究质量及数量限制,望日后得到更多优质RCT研究佐证。

Objective To evaluate the effectiveness and safety of oral Chinese patent medicine combined with metoprolol in the treatment of ventricular prephase contraction of coronary heart disease(CHD)by network Metaanalysis.Methods RCTs of oral Chinese patent medicine in the treatment of ventricular prephase contraction of CHD were searched in CNKI,Wanfang Data,VIP,PubMed,Embase and Cochrane Library.Cochrane risk assessment of bias was used to evaluate the quality of the included literature,and analyzed using RevMan5.3,GEMTC software,and Stata13.0.Results Thirty-three randomized controlled trials(RCTs)involving 5 kinds of Chinese patent drugs were included,with a sample size of 3898 cases.Shensong Yangxin capsule combined with metoprolol was the most likely to be the best intervention in the results of network meta-analysis of clinical effects,followed by Wenxin Granules combined with metoprolol.In terms of improving the ratio of 24 hours dynamic electrocardiogram results,Shensong Yangxin Capsule combined with metoprolol was the most likely to be the best intervention,followed by Wenxin Granules combined with metoprolol.In terms of improving EF value,Wenxin granule combined with metoprolol is the most likely to be the optimal treatment,followed by Naoxintong capsule combined with metoprolol.In terms of adverse reactions,the net analysis results showed no significant differences among the interventions.Conclusions Oral Chinese patent medicine combined with metoprolol can improve the clinical efficacy of ventricular prephase contraction of CHD with good safety.However,due to the limitations of research quality and quantity,more high-quality RCTs evidences are expected in the future.