基于文献研究痰瘀互结型高脂血症常用中药治疗规律及其系统评价

Systematic Evalution of Traditional Chinese Medicine Medication Principle in The Treatment of Phlegm and Blood Stasis Type Hyperlipidemia Based on Literature Research

目的系统整理和揭示痰瘀互结型高脂血症的临床用药规律,评价中医治疗痰瘀互结型高脂血症的临床疗效和安全性。方法收集1995年~2016年公开发表的痰瘀互结型高脂血症的临床研究文献,采用文献系统评价方法定性、定量分析,探究中医药治疗高脂血症常见证候—痰瘀互结证的证治规律及临床疗效。结果经筛选后,共纳入合格文献39篇,有完整处方名称(包括传统经方名称)32首方、没有取名但以"自拟经验方"作为名称7首方,涉及相关药物共77种,合计治疗患者1 612例。根据中药的功效及分类,使用频次较多的药物排名依次为活血化瘀药、补虚药、利水渗湿药、消食药、化痰药。最终纳入13篇临床随机对照试验的文献,采用Review Manager 5.3软件对符合标准的随机对照试验文献进行Meta分析。结果显示,与对照组相比,中医药治疗痰瘀互结型高脂血症能提高临床疗效(OR=2.71,P<0.000 1),升高HDL水平(OR=0.21,P<0.000 01)。结论治疗痰瘀互结型高脂血症的用药规律:痰瘀同治是高脂血症辨证论治的大法之一。中医药祛瘀化痰法治疗高脂血症具有较大的优势,但仍需要大样本随机对照试验来验证其有效性。

Objective To systematically evaluate the medication principle of traditional Chinese medicine in thetreatment of hyperlipidemia, and the curative effect and safety in traditional Chinese medicine from literature.Methods The clinical research literatures about the treatment of phlegm and blood stasis of hyperlipidemia publishedfrom 1995 to 2016 were collected, and systematic evaluation and meta-analysis on all the qualified clinicalresearches were carried out to explore the rule of syndrome and clinical treatment in traditional Chinese medicine.Results A total of 39 qualified literatures were referred,including 32 prescriptions with a complete prescription name（including traditional classical name）, 7 prescriptions without name as experience prescriptions, involving 77 related drugs,in sum of 1 612 patients. The most commonly used ten Chinese herbs for phlegm and blood stasistype hyperlipidemia,from high to low by frequency,are as follows：blood-activating and stasis-resolving drug,deficiency tonifying drugs,diuresis-inducing and dampness-draining drugs,digestion-promoting drugs,phlegm-resolving drugs. Thirteen RCTs were included and meta-analysis results indicated that compared with the controlgroup,the treatment group could improve the curative effect（OR=2.71,P〈0.0001） and HDL level（OR=0.21,P〈0.000 01）. Conclusion One of the most important treatments of phlegm and blood stasis type hyperlipidemia isto treat both phlegm and blood stasis simultaneously. The treatment of traditional Chinese medicine on phlegm andblood stasis type hyperlipidemia had more advantage in improving curative effect and HDL level. However,it stillneeds larger quantity of randomized controlled trials to verify the effectiveness.