冠心病中医血瘀证型与冠状动脉造影结果相关性的Meta分析

Correlation between TCM Blood Stasis Pattern of Coronary Heart Disease and Coronary Angiography Result: A Meta-Analysis

目的探讨冠心病中医血瘀证型与冠状动脉造影结果的相关性,筛选危险证型,为中医辨证客观化提供依据。方法计算机检索中国学术期刊网络出版总库(CAJD)、中国生物医学文献数据库(CBM)、中国博士学位论文全文数据库(CDFD)、中国优秀硕士学位论文全文数据库(CMFD)、PubMed和MEDLINE,并辅以手工检索方法收集国内外1992年1月～2012年5月公开发表和尚未发表的关于冠心病中医证型与冠状动脉造影结果关系的研究文献。按照纳入与排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入28篇文献,4 901例患者。Meta分析结果显示:血瘀证与冠状动脉病变支数[OR=1.38,95%CI(1.08,1.77),P<0.05]、狭窄程度[OR=1.79,95%CI(1.04,3.08),P<0.05]和Gensini积分[OR=7.74,95%CI(3.99,11.49),P<0.05]间均有明显的相关性。结论冠心病血瘀证型比非血瘀证型更易出现冠脉多支病变、75%以上的狭窄和更高的Gensini积分,说明血瘀证型比非血瘀证型冠脉病变严重。受原始研究辨证标准不统一、原始研究质量等因素的影响,本研究结果存在一定局限性,需谨慎应用,并期待开展更多大样本高质量的临床研究加以验证。

Objective To explore the correlation between traditional Chinese medicine （TCM） blood stasis pattern of coronary heart disease （CHD） and coronary angiography result, so as to screen dangerous patterns and provide evidence for the objectification of TCM pattern differentiation. Methods Literature on correlation between blood stasis pattern and coronary angiography results from January 1992 to May 2012 were searched in the following databases： China Academic Journal Network Publishing Database （CAJD）, Chinese Biomedical Literature Database （CBM）, China Doctor Dissertation Full-text Database （CDFD）, Chinese Selected Master＇s Theses Full-Text Databases （CMFD）, PubMed and MEDLINE. According to the inclusion and exclusion criteria, literature screening, data extraction and methodological quality assessment of the included studies were conducted. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 28 studies involving 4 901 patients were included. The results of meta-analysis showed that, there is a significant significance between blood stasis pattern and the following coronary angiography result, namely, number of culprit vessels （OR=1.38, 95%CI 1.08 to 1.77, P〈0.05）, severity of stenosis （OR=1.79, 95%CI 1.04 to 3.08, P〈0.05）, and Gensini score （OR=7.74, 95%CI 3.99 to 11.49, P〈0.05）. Conclusion Compared with other TCM patterns, CHD with blood stasis pattern easily tends to present multi-vessels lesions, more than 75% stenosis and higher Gensini score, in- dicating the condition of CHD with blood stasis pattern is more severe than with other patterns. Due to the discrepancy of pattern differentiation and the limited quality of original studies, this conclusion is insufficient to be fully applied into clinical practice, and more large scale and high quality clinical trials are reouired.