生脉散及其加味辅助治疗慢性心力衰竭临床疗效的Meta分析

Meta analysis of the clinical effect on treating chronic heart failureon with Shengmai San and its modified auxiliary

目的:系统性评价生脉散及其加味辅助常规西药与单纯常规西药治疗慢性心力衰竭的临床疗效。方法:电子检索中国知网(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库及Pub Med、Cochrane Library、EMbase,手工检索相关杂志,搜集关于单纯常规西药与生脉散及其加味辅助常规西药治疗慢性心力衰竭的随机对照试验,由两位研究者独立筛选文献、提取资料、评价方法学质量后,对符合标准的研究进行Meta分析。结果:共纳入6篇RCTs,总计612例患者。Meta分析显示:生脉散及其加味辅助常规西药,可提高慢性心衰治疗的总有效率[OR=2.56,95%CI(1.62,4.03),P<0.0001];可提高心脏的左室射血分数[MD=2.99,95%CI(0.48,5.51),P=0.02];可缩短LVEDd及LVESd,抑制心室重构[MD=2.93,95%CI(1.45,4.41),P=0.0001][MD=1.29,95%CI(0.47,2.11),P=0.002];气阴两虚型心衰亚组[RR=4.14,95%CI(2.16,7.95),P<0.0001]与未分型心衰亚组[OR=2.95,95%CI(1.50,2.82),P=0.002]差异有统计学意义,提示对改善心衰中医证候有显著疗效;各有1篇RCT对6 min步行距离及生活质量进行了评价,提示生脉散加味治疗更能有效改善心功能状况,提高心衰的预后。结论:与单纯常规西药治疗相比,生脉散及其加味辅助常规西药可进一步提高慢性心力衰竭的临床疗效。

Objective:To review Meta analysis of the clinical effect on treating chronic heart failureon with Shengmai San and itsmodified auxiliary. Method: We systematically searched the CNKI, VIP, Wanfang, CBM, PubMed, Cochrane Library, EMbase databasesand other related periodicals to identify randomized controlled trials (RCTs). Two researchers independently screened the literature,extracted data and evaluated the methodological quality of included studies, and carried out meta-analysis. Results: Six RCTs involved, 612patients were included. The results of meta-analysis showed: Western medicine plus pulse - activating powder added formula couldimprove the total efficiency rate of chronic heart failure treatment[OR = 2.56,95% CI (1.62,4.03),P<0.0001]; and could enhance theleft ventricular ejection fraction of the hear[t MD = 2.99,95% CI (0.48,5.51),P=0.02]; It could shorten the distance of LVEDd and LVESd,inhibiting the ventricular remodeling[MD =2.93, 95% CI (1.45,4.41),P=0.0001][MD =1.29,95% CI (0.47,2.11),P=0.002];Twogroup had statistically significant differences,showed that can improve the cardiac function; Pulse - activating powder plus addedformulaern can improve prognosis and life quality of patients with CHF,respectively. Conclusion: Compared with western medicine,western medicine plus Sheng Mai San or added formula can further improve the curative effects of CHF patients.