黄芪和丹参联用治疗冠心病的疗效评价及Meta分析

Efficacy Evaluation and Network Meta-Analysis of Therapeutic Effect of Huangqi(Astragali Radix) Combined with Danshen(Salviae Miltiorrhizae Radix Et Rhizoma) on Coronary Heart Disease

目的血瘀证是冠心病的主要中医证候,活血化瘀是目前中西医临床治疗的主要法则。气为血之帅,气行则血行,因此益气活血法有着中医理论基础。该文采用网状meta分析对黄芪和丹参联用治疗冠心病的疗效进行系统评价,为临床合理用药提供科学依据。方法计算机检索中国知网(CNKI)、维普网(VIP)、万方数据库(Wan Fang Data)和中国临床试验注册中心(http://www.chictr.org.cn)。外文检索PubMed,EMbase和The Cochrane Library。检索时间自建库至2020年1月。搜集黄芪、丹参以及二者联用治疗冠心病的随机对照临床试验研究。由2位研究人员独立进行文献筛选,数据提取和质量评价。采用RevMan 5.3和stata 15.0软件进行网状Meta分析。结果共纳入18个随机对照试验,包括黄芪注射液、丹参注射液以及黄芪注射液联合丹参注射液治疗冠心病4533例。对照组多为消心痛等常规西药,治疗组多在西药基础上增加中药治疗。观察指标主要是心绞痛发作减少和临床症状改善的有效率。网状Meta分析结果显示:异质性检验tao方最大值为0.27,<1.12无异质性,P值为0.0713,0.05<P<0.1,存在轻度异质性,故本文采用随机效应模型进行分析。结果是黄芪联合丹参组与丹参组疗效比较差异显著OR=2.07,95%CI(1.05,4.09)。黄芪联合丹参组与黄芪组疗效比较差异显著OR=2.98,95%CI(1.26,7.08)。疗效排序结果发现黄芪联合丹参组在5组中疗效最佳。结论当前证据表明,黄芪和丹参联合应用治疗冠心病较单独应用能显著提高临床疗效。

Objective Blood stasis syndrome is the main TCM syndrome of coronary heart disease,and promoting blood circulation and removing blood stasis is the main principle of clinical treatment both of traditional Chinese and Western medicine.Qi is the leading power of blood circulation.Therefore,the method of invigorating Qi can help to activate blood circulation.In this paper,the effectiveness of Huangqi(Astragali Radix,HQ)combined with Danshen(Salviae Miltiorrhizae Radix Et Rhizoma,DS)which can invigorate Qi in the treatment of coronary heart disease(CHD)was systematically evaluated by network Meta-analysis(NMV).Methods The databases including PubMed,EMBASE,the Cochrane Library,CNKI,VIP,Wan Fang and China clinicaltrial registration center were searched by computer.The retrieval time was from the establishment of the database to January 2020.A randomized controlled clinical trials of HQ,DS and their combination in the treatment of CHD were collected.Literature selection,data extraction and quality evaluation were carried out independently by two researchers.Revman 5.3 and Stata 15.0 software were used for NMV.Results A total of 18 randomized controlled trials were collected,including 4,533 CHD patients.The control group was mainly composed of routine western medicine,while the treatment group was mainly HQ,DS and HQ together with DS.The main outcome measures were the reduction of angina pectoris and the improvement of clinical symptoms.The NMV results showed that heterogeneity test tao2=0.27,lower than1.12,but P=0.0713,0.05<P<0.1,there was slight heterogeneity,and so the random effect model was used for the analysis.The results showed that the effect of HQ combined with DS was significant increased than HQ or DS alone[OR=2.07,95%CI(1.05,4.09);OR=2.98,95%CI(1.26,7.08)].HQ combined with DS had the best effect in the 5 treatment groups.Conclusion The current evidence shows that the combination of HQ and DS can significantly improve the clinical efficacy on the treatment of CHD.