益气活血法治疗冠心病心绞痛临床研究文献的Meta分析

Meta analysis of clinical research literature on supplementing qi and activating blood circulation for coronary heart disease

目的:对中医益气活血法治疗冠心病心绞痛(CHD)的有效性作出较客观的评估.方法:(1)检索1997/2007国内发表的益气活血法治疗CHD临床试验的相关文献,采用Review Manager 4.2软件对符合条件的文献进行Meta分析;(2)进行二次筛选并进行Jadad评分,筛选和评价过程由2位研究者独立进行,意见不同者通过讨论解决;(3)Meta分析,采用Cochrane协作网提供的Review Manager 4.2软件进行统计分析.结果:23篇文献进入Meta分析,总病例1639例.Meta分析显示与常规西药(消心痛为主)治疗相比,加用益气活血干预对CHD患者心绞痛临床疗效、心电图改善率、血液流变学的影响均有统计学差异,综合结果分别为:心绞痛临床疗效:RR[95%CI]为4.58[3.47,6.04],P<0.001;心电图改善率:RR为2.94[2.32,3.71],P<0.001;治疗后血液流变学主要指标低于对照组,其中全血高切粘度:WMD为-0.45[-0.55,-0.34],P<0.001;血浆粘度:WMD为-0.16[-0.19,-0.13],P<0.001;红细胞压积:WMD-3.82[-3.85,-3.801],P<0.001;全血低切粘度:WMD-0.93[-1.31,-0.55],P<0.001.结论:与单纯常规西药治疗相比,加用益气活血中药对增加心绞痛临床疗效有效率和心电图改善率、降低血液流变学各指标有益.

AIM： To make an objective evaluation on the validity of supplymenting qi and activating blood circulation for coronary heart disease （CHD）. METHODS： （ 1 ） The related literature concerning the clinical trials of supplymenting qi and activating blood circulation in treating CHD published domestically between 1997 and 2007 was retrieved,and Meta analysis was conducted on the selected literature by means of Review Manager 4.2 software. （2） Literature belting and scoring were performed by 2 researchers independently according to the Jadad scoring. If diferent opinions appeared, agreement was achieved through discussion. （3）Review Manager 4.2 offered by Cochrane was used to do the Meta analysis. RESULTS： Twenty-three literatures came into Meta analysis（ 1639 cases）. Compared with basic western medicine （Isosrbide Dinitrate）, additional supplymenting qi and activating blood circulation improved heart stroke clinical efficacy, ECG, hemorrheology of CHD patients. As for the former two, RR[95% CI] was 4. 5813.47, 6.04] and 2.94 [2.32,3.71] （P 〈 0.001 ）. The respectively hemorrheological indices were lower compared with the control group. The weighted mean difference （WMD） value of high cut blood viscosity was -0.45 [ -0.55, -0.34] （P 〈 0. 001 ）; The WMD value of plasma viscosity was -0.16[ -0.19, -0. 13] （P〈0.001）; The WMD value of haematoerit（HCT） was -3.82 [ -3.85, -3.801] （P〈 0.001 ） ; The WMD value of low cut blood viscosity was - 0.93 [ - 1.31, - 0.55 ] （P 〈 0. 001 ）. CONCLUSION： Meta analysis shows that supplymenting qi and activating blood circulation has some benefits in improving heart stroke clinical efficacy, ECG and reducing hemorrheology of CHD patients.