中药汤剂治疗急性心肌梗死疗效及安全性的系统评价及Meta分析

Efficacy and safety of Chinese herbal decoction for acute myocardial infarction: a systematic review and Meta analysis

目的评价中药汤剂治疗急性心肌梗死的疗效和安全性。方法检索Cochrane图书馆(2014年)、MEDLINE、中国学术期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)等数据库。检索不受发表语种限制,检索年限均为建库起至2015年12月20日。纳入中药汤剂干预急性心肌梗死的临床随机对照试验。按照数据提取表提取数据,采用Cochrane协作网推荐的评价标准对纳入试验进行质量评价,Rev Man 5.1软件进行资料分析,检验异质性,并根据异质性结果选择相应的效应模型。结果共纳入符合标准的21篇临床随机对照试验,共计1 819例患者。与常规治疗组比较,中药汤剂联合常规治疗可有效提高急性心肌梗死的冠脉血管再通率[RR=1.36,95%CI(1.16,1.59),P=0.0001],显著减少恶性心律失常[RR=0.52,95%CI(0.38,0.70),P<0.01]、心力衰竭[RR=0.48,95%CI(0.32,0.71),P=0.0003]及心源性休克[RR=0.53,95%CI(0.31,0.90),P=0.02]的发生。3项研究报道了不良反应。结论中药汤剂联合常规治疗能够有效提高急性心肌梗死的冠脉血管再通,具有显著减少恶性心律失常、心力衰竭及心源性休克等并发症发生的作用。

Objective To evaluate the efficacy and safety of Chinese herbal decoction for acute myocardial infarction（ AMI）. Methods The Cochrane Central Register of Controlled Trials（ CENTRAL） in the Cochrane Library, MEDLINE, CNKI, VIP,CBM,were searched. The retrieval was free from languages and covered the periods from the establishment of database to 20 December2015. The randomized clinical trials about the intervention of AMI with Chinese herbal decoction were included. The data were extracted according to the data table and the quality of included trials was evaluated according the standards recommended by Cochrane. Rev Man5. 1 software was used to analyze the data,test the heterogenicity,based on the results of which,the corresponding effect model was selected. Results 21 articles about the clinical randomized controlled trials with 1819 patients who followed the inclusion criteria were included. Compared with the routine treatment group,the recanalization rates were improved significantly from baseline with Chinese herbal decoction in combination with routine treatment [RR = 1. 36,95% CI（ 1. 16,1. 59）,P = 0. 0001 ],severe arrhythmia [RR= 0. 52,95% CI（ 0. 38,0. 70）,P 〈 0. 01 ],heart failure [RR = 0. 48,95% CI（ 0. 32,0. 71）,P = 0. 0003] and cardiogenic shock [RR = 0. 53,95% CI（ 0. 31,0. 90）, P = 0. 02] of AMI were reduced. 3 articles reported adverse reactions. Conclusion Chinese herbal decoction in combination with routine treatment appears to improve the recanalization rates of coronary artery and reduce the onset of complications such as severe arrhythmia,heart failure and cardiogenic shock of AMI.