丹参酮ⅡA磺酸钠对慢性肺心病血液流变学影响的系统评价

Systematic Evaluation of Tanshinone ⅡA Sodium Sulfonate on Hemorheology in Chronic cor Pulmonale

目的系统评价丹参酮ⅡA磺酸钠在改善慢性肺源性心脏病血液流变学的疗效及安全性。方法计算机检索Pub Med、EMbase、Web of Science、CBM、CNKI、VIP和Wan Fang Data,检索时限均为从建库至2016年9月4日。由2位评价员按纳入与排除标准独立筛选文献,提取资料并评价偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果纳入17个随机试验,共1625例患者。Meta分析结果显示,与对照组相比,丹参酮ⅡA磺酸钠组有效率高[OR=4.64,95%CI(3.31,6.51),P<0.05,I^2=0%],能降低经敏感性分析后的低切全血黏度[MD=-1.10,95%CI(-1.40,0.79),I^2=7%],降低经敏感性分析后红细胞聚集率[MD=-0.18,95%CI(-0.20,-0.16),P<0.05,I^2=0%],降低血小板聚集率[MD=-0.08,95%CI(-0.11,-0.05),P<0.05,I^2=0%],肺动脉收缩压[MD=-8.77,95%CI(-9.48,-8.06),P<0.05,I^2=40%]。差异均有统计学意义。结论目前临床证据显示,常规治疗基础上,联合丹参酮ⅡA磺酸钠对改善慢性肺心病患者的血液流变学一定疗效及安全性。但由于研究质量和样本量限制,仍需更多高质量、多中心、大样本的随机双盲试验以证实。

Objective To systematically analyse the efficacy and safety of tanshinone ⅡA sodium sulfonate on improving hemorheology in chronic pulmonary heart disease. Methods Data was retrieved from Pub Med, EMbase, Web of Science, CBM, CNKI, VIP and WANFANG Data from the dates of databases construction to September 4, 2016.The literatures were screened independently by 2 reviewers according to inclusion and exclusion criteria. After extracting data and evaluating bias risk, Rev Man 5.2 software was used for meta-analysis. Results A total of 17 studies involving 1625 participants were included. Main outcomes of the meta-analysis showed that： compared with conventional treatment group,tanshinone ⅡA sodium sulfonate combined conventional treatment group have the higher effective rate（OR=4.64, 95 % CI [（3.31, 6.51], P〈0.05, I^2=0 %）, lower shear whole blood viscosity after sensitivity analysis（MD=-1.10, 95 % CI [-1.40, 0.79], I^2=7 %）, erythrocyte aggregation rate after sensitivity analysis（MD=-0.18,95 %CI [-0.20,-0.16],P〈0.05, I^2=0 %）,platelet aggregation rate（MD=-0.08,95 %CI[-0.11,-0.05],P〈0.05,I^2=0 %）,and pulmonary artery systolic pressure（MD=-8.77,95 %CI [-9.48,-8.06],P〈0.05,I^2=40 %）. Significant difference was found. Conclusion According to the existing evidence,tanshinone ⅡA sodium sulfonate had a safe and curative effect on hemorheology of chronic pulmonary heart disease. However,as most of the included studies were regarded as low qualities,more well-designed studies should be done.