运用Markov模型评价益气活血中药干预不稳定性心绞痛远期疗效的探索

Assessing Chinese Herbal Medicines for Benefiting Qi and Activating Blood Circulation in Treating Unstable Angina Based on Markov Model:a Long-term Clinical Effectiveness Exploration

目的基于Markov模型评价益气活血中药联合西医常规干预不稳定性心绞痛(unstable angina,UA)支架术后气虚血瘀证患者的远期疗效。方法根据益气活血中药联合西医常规干预、西医常规干预UA支架术后患者的预后和转归建立Markov模型。通过40个Markov周期的状态转移概率和人均累积获得质量调整生命年(quality-adjusted life years,QALYs)的比较,评价益气活血中药联合西医常规干预的疗效优势。结果经过Markov模型20年的预测,益气活血中药联合西医常规干预组血运重建、非致命性心肌梗死、非致命性中风、全因死亡的累积转移概率分别为56.65%、6.53%、5.16%、31.66%,人均累积QALYs为12.95;西医常规干预组相应的累积转移概率分别为55.31%、6.87%、5.25%、32.57%,人均累积QALYs为12.84。与西医常规干预比较,益气活血中药联合西医常规干预的人均增量QALYs为0.11。结论基于Markov模型的预测结果,益气活血中药联合西医常规干预UA支架术后患者的疗效优于西医常规干预,说明益气活血中药可以改善UA支架术后气虚血瘀患者的远期疗效。

Objective To assess the long-term clinical effectiveness of Chinese herbal medicines for benefiting qi and activating blood circulation （CHMBQABC） plus routine Western medical inter- vention in treating unstable angina CUA） patients of qi deficiency blood stasis syndrome （QDBSS） after percutaneous coronary intervention （PCI） based on Markov model. Methods A Markov model was es- tablished based on prognosis and sequelae of UA patients after PCI treated by CHMBQABC plus routine Western medical intervention or by routine Western medical intervention. According to the transition prob- abilities of 40 Markov cycles and quality-adjusted life years （QALYs） averageiy gained, we assessed the therapeutic advantage of CHMBQABC plus routine Western medical intervention. Results By the predic- tion of Markov model for 20 years, the transition probabilities of revascularization, non-fatal myocardial infarction, non-fatal stroke, and all-cause death in the CHMBQABC plus routine Western medical inter- vention group was 56.65%, 6.53%, 5.16%, and 31.66%, respectively, and the QALYs averagely gained was 12.95~ while the transition probabilities of revascularization, non-fatal myocardial infarction, non-fatal stroke, and all-cause death in the Western medical intervention group was 55.31%, 6.87%, 5.25%, and 32.57%, respectively, and the QALYs averagely gained was 12.84. Compared with the Western medical intervention group, the QALYs averagely gained was 0.11 in the CHMBQABC plus rou- tine Western medical intervention group. Conclusion Based on predicted results of the Markov model, CHMBQABC plus routine Western medical intervention got better efficacy in treating UA patients after PCI, indicating CHMBQABC plus routine Western medical intervention could improve the long-term clinical effectiveness for UA patients of QDBSS after PCI.