中药联用ARBs治疗高血压病左心室肥厚疗效性与安全性系统评价

Systematic Review of the Efficacy and Safety of Traditional Chinese Medicine Combined with ARBs in the Treatment of Hypertensive Left Ventricular Hypertrophy

目的:分析中药联用血管紧张素受体拮抗剂(ARBs)治疗高血压病左心室肥厚(LVH)疗效与安全性。方法:计算机检索从建库至2019年12月31日PubMed、Cochrane Library、Embase、Web of Science、中国知网、维普、CBM、Wanfang Data数据库的文献,按照纳排标准选择文献并完成质量评价后,采用Rev Man 5.3软件进行系统评价。结果:最终纳入13个随机对照试验,共计1178例患者。结果显示:(1)逆转LVH方面:LVDd(P=0.13,WMD=-1.72,95%CI:-3.95~0.52);IVST(P=0.009,WMD=0.44,95%CI:0.11~0.77);LVPWT(P=0.0003,WMD=-0.91,95%CI:-1.40~-0.42);LVMI(P<0.0001,WMD=-8.16,95%CI:-11.97~-4.34);除LVDd外,各指标组间均具有统计学意义。(2)降压疗效:SBP(P=0.001,WMD=-6.40,95%CI:-10.35~-2.45);DBP(P=0.0007,WMD=-4.37,95%CI:-6.90~-1.84);SBP、DBP组间均具有统计学意义。(3)临床症状改善率:(P<0.00001,RR=1.21,95%CI:1.11~1.32),组间比较具有统计学意义。结论:该系统评价结果提示中药联用ARBs具有更好的逆转LVH和降压疗效,改善临床症状效果更佳。

Objective:To analyze the curative effect and safety of traditional Chinese medicine combined with ARBs in the treatment of LVH.Methods:The databases of PubMed,Cochrane Library,Embase,Web of Science,CNKI,VIP,CBM,Wanfang Database were retrieved on line from database foundation to December 31,2019.After chosen the documents according to the inclusion and exclusion criteria and evaluating the quality,Systematic review was performed with Rev Man 5.3 software.Results:There were totally13 RCTs included,involving 1178 patients.The results showed that(1)Reversing LVH effect:LVDd(P=0.13,WMD=-1.72,95%CI:-3.95~0.52),IVST(P=0.009,WMD=0.44,95%CI:0.11~0.77),LVPWT(P=0.0003,WMD=-0.91,95%CI:-1.40~-0.42),LVMI(P<0.0001,WMD=-8.16,95%CI:-11.97~-4.34),except LVDd,all the index groups have statistical significance differences.(2)anti-hypertensive effect:SBP(P=0.001,WMD=-6.40,95%CI:-10.35~-2.45),DBP(P=0.0007,WMD=-4.37,95%CI:-6.90~-1.84),SBP and DBP groups have statistical significance differences.(3)Clinical symptom improvement rate:(P<0.00001,RR=1.21,95%CI:1.11~1.32),showed statistical significance differences between two groups.Conclusion:The results of systematic review suggest that traditional Chinese medicine combined with ARBs has better effects of reversing LVH and lowering blood pressure,and improving clinical symptoms.