益气养阴活血类中成药治疗冠心病稳定型心绞痛的Meta-分析

Meta-Analysis of Treatment of Stable Angina Pectoris of Coronary Heart Disease by Chinese Patent Medicine for Reinforcing Qi,Replenishing Yin and Promoting Blood Circulation

目的:系统评价益气养阴活血类中成药治疗冠心病稳定型心绞痛的临床疗效。方法 :搜集益气养阴活血类中成药治疗冠心病心绞痛的随机对照试验和半随机对照试验,采用Revman5.2软件进行异质性检验、Meta-分析、敏感性分析、侧漏斗图分析。结果:共计12篇随机对照试验1 467例患者符合纳入标准,但纳入研究的方法学质量普遍较低。Meta-分析结果示益气养阴活血类中成药在改善心电图表现方面合并效应量RR=1.26,95%CI[1.13,1.41],在改善患者血脂方面合并效应量SMD=-0.21,95%CI[-0.37,-0.06],在总有效率方面合并效应量RR=1.19,95%CI[1.14,1.25],差异均有统计学意义;敏感性分析提示结果稳定性好;侧漏斗图分析显示图形不对称,说明存在发表偏倚。结论:现有证据表明在常规治疗基础上加用益气养阴活血类中成药可提高冠心病稳定型心绞痛的临床疗效,但由于纳入研究质量低,尚需开展大样本、多中心、严格设计的高质量随机对照试验进行验证。

Objective：To systematically evaluate the clinical effect of Chinese patent medicine for reinforcing qi,replenishing yin and promoting blood circulation on stable angina pectoris of coronary heart disease（CHD）. Methods：Randomized controlled trials（RCTs） and quasi-RCTs of treatment of stable angina pectoris of CHD by Chinese patent medicine for reinforcing qi,replenishing yin and promoting blood circulation were selected. The analyses of heterogeneity,Meta-,sensitivity and publication bias were performed by Revman 5.2.Results：1 467 patients in 12 trials were included,but their qualities were generally low. The results of metaanalysis showed that in improveing ECG manifestation,RR=1.26,95% CI [1.13,1.41];in improving the blood lipid level,SMD=-0.21,95% CI[-0.37,-0.06];in improving total effective rate,RR=1.19,95% CI[1.14,1.25].All the differences were statistically significant. The sensitivity analysis showed that the results were stable.The funnel plot was asymmetric,which meant there was publication bias. Conclusion：Current evidence suggests that adding Chinese patent medicine for reinforcing qi,replenishing yin and promoting blood circulation on basis of conventional treatment can improve the clinical effect on stable angina pectoris of CHD.However,taking the poor methodological quality of the included studies into consideration,high-quality trials with large sample size,multicenter and strict design are needed to verify their clinical effects.