瓜蒌薤白半夏汤治疗胸痹的Meta分析

Meta-analysis of Gualou Xiebai Banxia Decoction for Xiongbi

目的:系统总结瓜蒌薤白半夏汤的临床应用,应用Meta分析评价瓜蒌薤白半夏汤治疗胸痹(包括冠心病、慢性阻塞性肺疾病、肺源性心脏病)的疗效。方法:从知网、万方、CBM等中文数据库中查找关于瓜蒌薤白半夏汤的现代文献,共检索出文献948篇,筛选并删除重复文献,通过纳入及排除标准后余346篇。就这些文献中瓜蒌薤白半夏汤的主治疾病及证候、常用方药配伍做系统总结。同时,对瓜蒌薤白半夏汤治疗冠心病、慢性阻塞性肺疾病、肺源性心脏病的随机对照试验进行Meta分析,定量分析瓜蒌薤白半夏汤治疗胸痹的临床疗效。结果:瓜蒌薤白半夏汤在临床上可用于治疗多个系统疾病、如心血管系统、呼吸系统、消化系统、内分泌系统、妇科疾病等,治疗该系统病症多属痰浊内阻证,常配伍化痰活血理气药如丹参、甘草、桂枝、茯苓、陈皮、川芎、郁金、当归、赤芍、枳实、红花等。Meta分析提示,与对照组相比,瓜蒌薤白半夏汤治疗冠心病心绞痛的临床疗效OR[95%CI]为2.89[1.83,4.57],P<0.00001,心电图疗效OR[95%CI]为3.56[1.87,6.75],P<0.0001,治疗慢性阻塞性肺疾病临床疗效OR[95%CI]为3.41[1.89,6.15],P<0.0001,治疗慢性肺源性心脏病临床疗效OR[95%CI]为4.25[2.39,7.56],P<0.00001,差异均有统计学意义。结论:瓜蒌薤白半夏汤在临床上主要适用于痰涎壅盛所致的胸阳痹阻不通之证,根据异病同治原则可用于现代医学的冠心病心绞痛、肺心病、阻塞性肺疾病、心律失常、高脂血症、神经官能症、病毒性心肌炎、慢性胃炎等多种疾病的治疗之中。Meta分析表明,瓜蒌薤白半夏汤治疗冠心病心绞痛、肺心病、慢性阻塞性肺疾病疗效是肯定的。由于样本量较小,若想进一步验证疗效,需要进行大样本、多中心随机对照试验。

Objective： To systematically summarize the clinical application of Gualou Xiebai Banxia Decoction（ GXBD） and evaluate the clinical effect in the treatment of Xiongbi including coronary heart disease angina（ CHD）,chronic obstructive pulmonary diseases（ COPD） and pulmonary heart disease（ PHD） by using the Meta-analysis. Methods： A total of 948 related literature of GXBD were retrieved in CNKI,WANFANG DATA,CBM database and 346 pieces of qualified literature were filtered through the inclusion criteria and exclusion criteria. Make system summary of attending syndrome and commonly-used prescriptions of GXBD by analyzing these qualified literature. Meanwhile,use the Meta-analysis to evaluate the clinical effect of GXBD in the treatment of CHD,COPD and PHD. Results： GXBD can be used in many systems like cardiovascular system,respiratory system,digestive system,endocrine system,gynecological diseases,etc. It was used to treat internal obstruction of phlegm-turbid syndrome with other Chinese medicinal herbs like Danshen,Gancao,Guizhi,Fuling,Chenpi,Chuanxiong,Yujin,Danggui,Chishao,Zhishi,Honghua,etc. Meta-analysis revealed that the clinical effect of GXBD in the treatment of CHD was higher than that of the control group（ OR[95% CI = 2. 89 [1. 83,4. 57],P〈0. 00001） and the ECG curative effect of GXBD was better than that of the control group（ OR[95% CI = 3. 56[1. 87,6. 75],P〈0. 0001）. So were COPD（ OR[95% CI]= 3. 41[1. 89,6. 15],P〈0. 0001） and PHD（ OR[95% CI]= 4. 25[2. 39,7. 56],P〈0. 00001）. Conclusion： GXBD is suit for internal obstruction of phlegm-turbid which leads to phlegm-turbidity obstructing the chest-yang,qi flow and the meridians collateral. It can be used to treat different diseases like CHD,PHD,COPD,arrhythmia,hyperlipidemia disease,neurosis,viral myocarditis,blocking lung disease,chronic gastritis and so on depend on the principle of the same syndrome with different disease. The Meta-analysis indicates that GXBD is safe and effective in the treatment of CHD,PHD and COPD. However,rigorous design and large sample randomized controlled trial are still needed to verify and support its clinical effectiveness.