基于Meta分析的艾灸治疗冠心病心绞痛临床疗效评价

Efficacy Evaluation of Moxibustion Therapy for Angina Patients with Coronary Artery Disease

目的对艾灸治疗冠状动脉粥样硬化性心脏病(冠心病)心绞痛的临床疗效进行系统评价。方法以循证医学Cochrane系统评价为平台,通过主题词和自由词相结合的方式,检索Pubmed、Embase、Cochrane Library、中国生物医学数据库(CBMDisk)、中国知网(CNKI)、万方数据库、中国临床试验注册中心(检索时间至2014年1月),追查相关的参考文献,必要时联系作者。按照纳入标准与排除标准筛选文献,应用风险评估工具对纳入研究的质量进行评价,提取数据后运用Rev Man5.2软件进行Meta分析。结果按照相关标准共筛选出临床试验13项,纳入患者1 318例。Meta分析结果显示:与对照组比较,艾灸组在心绞痛症状改善方面,与西药组比较[RR=1.22,95%CI(1.11,1.33)],与针刺组比较[RR=1.5,95%CI(1.23,1.83)],疗效较好,有显著性差异;在心电图改善方面亦具有较好疗效[RR=1.23,95%CI(1.14,1.33)];在调节血脂方面,甘油三酯[SMD=-0.81,95%CI(-1.57,-0.06)]、低密度脂蛋白胆固醇[SMD=-0.55,95%CI(-1.04,-0.06)]、高密度脂蛋白胆固醇[SMD=0.43,95%CI(0.2,0.65)],具有较好疗效,有统计学意义。艾灸组与中药组比较,心绞痛改善情况无统计学差异[RR=1.15,95%CI(0.99,1.35)];总胆固醇的改善情况试验组与对照组比较无统计学差异[SMD=-0.74,95%CI(-1.75,0.27)]。结论艾灸是治疗冠心病心绞痛有效的中医特色疗法,临床中可加以推广应用。同时应该审慎看待本系统的评价结论,期待有更多高质量的临床对照试验纳入Meta分析以提高证据级别。

OBJECTIVE To evaluate the benefits and side effects of moxibustion therapy for coronary artery disease. METHODS Relevant studies of moxibustion therapy for angina were collected from databases including Pubmed, Embase,Cochrane library,CNKI, Wanfang Database and CBMDisk. The inclusion and exclusion criteria was applied when the literature was screened, data was extracted and the quality of the included studies were assessed independently. Then, meta-analysis was performed by using Rev Man 5.2 software. RESULTS 1 318 patients and 13 researches about moxibustion therapy for coronary artery disease were collected. The Meta analysis showed that compared with the control group, the western medicine group[RR = 1. 22,95% CI（ 1. 11,1. 33） ]and the acupuncture group[ RR = 1. 5,95% CI（ 1. 23,1. 83） ], the moxibustion group showed great improvement in relieving angina pectorisis and good effects were shown in the ECG[ RR = 1. 23,95% CI（ 1. 14,1. 33） ]. In terms of blood liquids, the moxibustion group showed good effects in regulating triglyceride[SMD =-0. 81,95% CI（-1. 57,-0. 06） ], low density lipoprotein cholesterin[ SMD =-0. 55,95% CI（-1. 04,-0. 06） ], and high density lipoprotein cholesterol[ SMD = 0. 43,95% CI（ 0. 2,0. 65） ] and the changes were of statistical significance. Compared with the Chinese medicine group, the improvement in angina pectorisis of the moxibustion group showed no statistical significance[ RR = 1. 15,95% CI（ 0. 99,1. 35） ]. The difference between the changes of total cholesterol in the treatment group and the control group had no statistical significance[ SMD =-0. 74,95% CI（-1. 75,0. 27） ]. CONCLUSION Moxibustion is a unique TCM therapy in treating angina pectorisis and can be applied in clinical practices. Meanwhile, the outcome of this system was not perfect.And more high quality of randomized controlled trials are needed to verify the effect of the therapy.