中药注射液治疗不稳定型心绞痛对患者血脂水平影响系统评价和网状Meta分析

Effect of Traditional Chinese Medicine Injection for Unstable Angina Pectoris on Blood Lipid Level:Systematic Review and Network Meta-Analysis

目的评价不同中药注射液治疗不稳定型心绞痛对患者血脂水平的影响。方法计算机检索PubMed、Cochrane Library、Web of Science、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP Data)、万方数据库(WanFang Data)中有关中药注射液治疗不稳定型心绞痛的随机对照试验,所有研究员均独立筛选文献、提取资料、质量评价,对符合质量标准的研究采用OpenBUGS和Stata软件进行数据分析。结果共纳入69项研究,涉及22种干预措施,在降低血清总胆固醇(TC)方面,舒血宁、丹红、血塞通、参芎葡萄糖、疏血通、银杏达莫、丹参酮ⅡA磺酸钠和灯盏花素联合常规西医均优于单纯常规西医治疗,舒血宁联合常规西医优于复方丹参联合常规西医治疗;在降低甘油三酯(TG)方面,舒血宁、丹参、红花黄色素、丹红、血塞通和疏血通联合常规西医均优于单纯常规西医治疗,舒血宁、丹参、红花黄色素和丹红联合常规西医优于复方丹参或灯盏花素联合常规西医治疗,血塞通联合常规西医优于灯盏花素联合常规西医治疗;在降低低密度脂蛋白胆固醇(LDL-C)方面,舒血宁、血塞通和丹红联合常规西医均优于单纯常规西医治疗,舒血宁联合常规西医优于丹红、复方丹参、丹参川芎嗪、参芎葡萄糖、疏血通、银杏达莫、丹参、血必净、灯盏花素、瓜蒌皮、苦碟子和香丹联合常规西医治疗;在提高高密度脂蛋白胆固醇(HDL-C)方面,舒血宁、丹参酮ⅡA磺酸钠、丹参、红花黄色素和丹红联合常规西医治疗均优于单纯常规西医治疗,舒血宁或丹参酮ⅡA磺酸钠联合常规西医优于丹参川芎嗪或灯盏细辛联合常规西医治疗,舒血宁联合常规西医优于丹红、疏血通、血必净、复方丹参、银杏达莫、血塞通、葛根素、苦碟子和参芎葡萄糖联合常规西医。结论现有证据表明,根据SUCRA排序结果,舒血宁联合常规西医治疗在降脂方面成为最好的干预措施的可能性最大,推荐临床使用。受纳入研究质量的限制,所得结论仍待进一步的临床研究证实。

Objective To evaluate the effect of different traditional Chinese medicine injections on the blood lipid levels of patients with unstable angina pectoris.Methods Randomized controlled trials on unstable angina pectoriswere retrieved from the Pub Med,Cochrane Library,Web of Science,CNKI,China Biomedical Medicine Database,VIP and Wan Fang Data.All researchers independently screened the literature,extracted data,and evaluated the quality,and used Open BUGS software and Stata software for data analysis for studies that met quality standards.Results A total of 69 studies were included,involving 22 intervention measures.In terms of lowering TC,Shuxuening(舒血宁),Danhong(丹红),Xuesaitong(血塞通),Shenxiong Glucose(参芎葡萄糖),Shuxuetong(疏血通),Yinxing Damo(银杏达莫),TanshinoneⅡA sodium sulfonate and Breviscapine combined with conventional Western medicine were better than simple conventional Western medicine,and Shuxuening combined with conventional Western medicine was better than Compound Danshen(复方丹参)combined with conventional western medicine;in terms of reducing TG,Shuxuening,Danshen Injection(丹参注射液),Safflower Yellow,Danhong Injection,Xuesaitong and Shuxuetong combined with conventional Western medicine were better than simple conventional Western medicine.Shuxuening,Danshen,Safflower Yellow and Danhong combined with conventional Western medicine were better than Compound Danshen or Breviscapine combined with conventional Western medicine.Xuesaitong combined with conventional Western medicine was superior in the treatment of Breviscapine combined with conventional Western medicine;in reducing LDL-C,Shuxuening,Xuesaitong and Danhong combined with conventional Western medicine were better than simple conventional Western medicine,and Shuxuening combined with conventional Western medicine was better than Danhong,Compound Danshen,Danshen Ligustrazine,Shenxiong Glucose,Shuxuetong,Yinxing Damo,Danshen,Xuebijing(血必净),Breviscapine,Gualoupi(Trichosanthis Pericarpium),Kudiezi and Xiangdan combined with conventional Western medicine treatment;in improving HDL-C,Shuxuening,TanshinoneⅡA sodium sulfonate,Salvia Miltiorrhiza,Safflower Yellow and Danhong combined with conventional Western medicine treatment were better than conventional Western medicine treatment alone,and Shuxuening or TanshinoneⅡA sulfonate sodium combined with conventional Western medicine was better than Danshen or Breviscapine combined with conventional Western medicine treatment,Shuxuening combined with conventional Western medicine was better than Danhong,Shuxuetong,Xuebijing,Compound Danshen,Yinxing Damo,Xuesaitong,Puerarin,Kudiezi and Shenxiong Glucose combined with conventional Western medicine.Conclusion According to the results of SUCRA ranking,the existing evidence shows that Shuxuening combined with conventional Western medicine has the greatest possibility of becoming the best intervention in lipid-lowering,and clinical use is recommended.Limited by the quality of the included studies,the conclusions reached still need to be confirmed by further clinical studies.