益气养阴活血法联合PCI术改善心肌微循环障碍疗效的Meta分析

Meta-Analysis of Efficacy of Reinforcing Qi,Replenishing Yin and Promoting Blood Circulation Combined with Percutaneous Coronary Intervention to Improve Myocardial Microcirculation

目的：系统评价益气养阴活血法联合PCI术改善心肌微循环障碍的临床疗效。方法：通过计算机检索益气养阴活血法联合PCI术改善冠心病心肌微循环的随机对照实验和半随机对照实验,并运用Revman 5.2软件进行Meta分析、异质性检验、敏感性分析、漏斗图分析。结果：本研究纳入11篇随机、半随机对照试验研究文献,实验研究例数共计952例。Meta分析结果显示益气养阴活血类中药联合PCI术临床治疗在总体有效率方面合并效应量：RR=1.15,95%CI（1.08,1.23）,差异有统计学意义;改善血液流变学方面结果显示MD=-0.22,95%CI[-0.31,-0.13],有统计学意义;缺血性心电图改善方面合并效应量RR=1.27,95%CI[1.12,1.44],具有统计学意义;中医证候积分评价MD=-3.27,95%CI[-4.22,-2.31],具有统计学意义;左室射血分数改善结果显示SMD=0.88,95%CI[0.42,1.34],有统计学意义;心肌声学造影评价显示合并效应量RR=1.56,95%CI[1.16,2.09],有统计学意义。漏斗图结果显示图形不对称,提示存在发表偏倚可能。结论：纳入的研究文献普遍存在方法学质量较低,现有证据表明临床运用益气养阴活血法联合PCI术治疗在改善冠心病患者微循环方面存在明显优势,但由于本次研究的局限性,仍需开展大样本、多中心、高质量随机对照试验进行疗效验证。

Objective： To evaluate the clinical efficacy of reinforcing Qi,replenishing Yin and promoting blood circulation combined with percutaneous coronary intervention in improving myocardial microcirculation. Methods： A randomized controlled trial and a semi-randomized controlled trial were conducted to improve the microcirculation of coronary heart disease（CHD） by the methods of reinforcing Qi,replenishing Yin and promoting blood circulation combined with PCI. The analyses of Meta-analysis,heterogeneity and sensitivity analysis were performed by Revman 5. 2. Results： A total of 952 patients in 11 randomized controlled trials were included. Meta-analysis showed that the clinical efficacy of reinforcing Qi,replenishing Yin and promoting blood circulation combined with percutaneous coronary intervention in improving myocardial microcirculation showed RR = 1. 15,95% CI（1. 08,1. 23）; in improving blood rheology level showed MD =-0. 22,95% CI [-0. 31,-0. 13]; in improveing ECG manifestation showed RR = 1. 27,95% CI [1. 12,1. 44 ]; in evaluation of TCM syndrome showed MD =-3. 27,95% CI [-4. 22,-2. 31]; in the score of left ventricular ejection fraction showed SMD = 0. 88,95% CI [0. 42,1. 34]; myocardial acoustics angiography showed that the combined effect RR = 1. 56,95% CI [1. 16,2. 09]. All the difference was statistically significant. The funnel graph shows the graphics asymmetry,suggesting that there may be a publication bias. Conclusion： The selected research literature qualities were generally low. There is a significant advantage in the clinical use of reinforcing Qi,replenishing Yin and promoting blood circulation combined with percutaneous coronary intervention in improving myocardial microcirculation. However,it needs to carry out a large sample,multi-center,high-quality randomized controlled trials for efficacy validation due to the limitations of this study.