中药联合西药治疗痰瘀互结型冠心病疗效及安全性Meta分析

Efficacy and Safety of Chinese Medicine and Western Medicine in the Treatment of Coronary Heart Disease with Phlegm-stasis Cementation Syndrome: A Meta-analysis

目的：评价中药联合西药治疗痰瘀互结型冠心病的疗效及安全性。方法：检索2007年1月—2017年4月中文数据库（CNKI、VIP、CBM、万方数据）及英文数据库（Medline、Cochrane Library）。研究对象为已确诊痰瘀互结型冠心病的患者,干预措施及比较类型为：中药加西药与单用西药比较治疗痰瘀互结型冠心病的随机、对照试验。采用Cochrane协作组织制定的偏倚风险评价标准对纳入研究的文献质量（包括随机化、分配、隐藏、盲法、退出与失访）进行评价,使用Revman 5.2软件对资料进行汇总分析。结果：36个以中文发表的RCTs（共3336个研究对象）被纳入研究。在西药常规治疗的基础上加用中药,可明显改善心绞痛疗效、心电图疗效、中医证候疗效、临床疗效和症状疗效,还可以明显改善血脂水平、血浆同型半胱氨酸水平,并无明显不良反应,安全有效。结论：中药和西药联用较单用西药在治疗痰瘀互结型冠心病方面可能具有优势,但还需进一步开展高质量的试验加以证实。

Objective： To assess the effectiveness and safety of Chinese medicine and western medicine in the treatment of coronary heart disease（ CHD） with phlegm-stasis cementation syndrome. Methods： databases in Chinese（ CNKI,VIP,CBM,and Wanfang Database） and in English（ Medline and Cochrane Library） dating from January 2007 to April 2017 were searched and relevant documents retrieved. Participants were patients confirmed by CHD with phlegm-stasis cementation syndrome. We included randomized clinical trials（ RCTs） testing Chinese medicine plus western medicine vs. western medicine. Assessments of methodological quality,including randomization,allocation,concealment,blindness,dropping out,and loss of follow-ups were also conducted according to the Cochrane Handbook for Systematic Review of Interventions. Meta-analysis was performed using Rev Man 5. 2 software provided by Cochrane Collaboration. Results： Thirty-six RCTs（ involving 3336 patients） were included. All these studies were published in Chinese. The results of Meta analysis showed that the group treated by Chinese medicine and western medicine could improve the efficacy of angina,electrocardiograph,TCM syndrome curative effect,clinical efficacy and symptom effect. It could also improve the level of blood lipid and homocysteine. The results showed that treatment with Chinese medicine and western medicine were safe and had no obvious side effects. Conclusion： Traditional Chinese medicine combined with western medicine in the treatment of CHD with phlegm-stasis cementation syndrome may have an advantage,which need to be confirmed by launching higher quality clinical trials.