针刺联合西药治疗冠心病心绞痛的系统评价

Acupuncture combined with western medicine for angina of coronary artery disease:a systematic review

评价针刺联合西药治疗冠心病心绞痛的疗效及安全性。检索Pubmed、Embase、Cochrane Library、中国生物医学文献数据库(CBMdisk)、中国知网(CNKI)、万方数据库、中国临床试验注册中心以及其他相关文献,检索时间从建库至2014年1月,共收集到针刺治疗冠心病心绞痛符合纳入标准的文献15篇,涉及研究11项,纳入患者1 232例。Meta分析结果显示在常规西药治疗基础上加用针刺治疗,可以进一步改善心绞痛症状、心电图疗效以及减少硝酸甘油用量;同时改善患者血液流变学、降低C反应蛋白(CRP)、丙二醛(MDA)、过氧化脂质(LPO)以及内皮素(ET),提高超氧化物歧化酶(SOD)和一氧化氮(NO)的含量,并且能减少心血管事件的发生率,无明显不良反应;某些结局指标改善情况(如动态心电图、全血黏度等)治疗组和对照组间差异无统计学意义,其余结局指标差异有统计学意义。认为针刺联合西医常规治疗,是治疗冠心病心绞痛有效的治疗方案,优于西医常规药物治疗;同时应该审慎看待本系统评价结论,期待有更多的高质量的临床试验纳入Meta分析以提高证据级别。

The effectiveness and safety of acupuncture combined with western medicine for angina of coronary artery disease are evaluated.Databases including Pubmed,Embase,Cochrane Library,CBMDisk,CNKI,Wanfang,Chinese Clinical Trial Registry,etc.are searched with search time from beginning of the database establishment to January of 2014.As a result,totally 15 articles of acupuncture for angina of coronary artery disease that met the inclusive criteria were collected,involving 11 researches and 1 232 patients.The results of Meta-analysis indicate that based on regular western medicine,additional use of acupuncture could further improve symptoms of angina,increase efficacy of electrocardiogram（ECG）and reduce the dosage of nitroglycerin,in the meanwhile the hemorheology could be ameliorated,and the contents of C reactive protein（CRP）,malondialdehyde（MDA）,lipid peroxide（LPO）,endothelin（ET）could be reduced,while the contents of superoxide dismutase（SOD）and nitric oxide（NO）could be increased;besides,the occurrence rate of cardiovascular event could be reduced without causing obvious adverse events.Except for certain outcomes（including dynamic ECG and blood viscosity）those have no statistical significance between treatment group and control group,the differences of remaining outcomes are statistically significant.It is believed that acupuncture combined with regular treatment of western medicine are effective treatment plan for angina of coronary artery disease,which are superior to regular treatment of western medicine,but the results of this systematic review be taken with caution,and more clinical trials with high quality are looking forward to be included into Meta-analysis to increase the level of evidence.