红花黄色素联合西药治疗冠心病不稳定型心绞痛的Meta分析

Safflower Yellow and Western Medicine in the Treatment of Unstable Angina:a Meta-analysis

目的系统地评价红花黄色素联合西药治疗冠心病不稳定型心绞痛的疗效。方法全面检索PubMed、Embase、Cochrane、Medline、CBM、知网、维普、万方等数据库中2015年12月之前发表的不稳定型心绞痛使用红花黄色素或红花黄色素联合用药治疗的随机对照研究(RCT),由2名研究者分别按照纳入与排除标准独立筛选出符合标准的RCT,并对纳入研究进行质量评分及提取资料。试验组使用常规治疗加红花黄色素治疗,对照组均使用常规治疗。采用Stata12.0进行相关Meta分析。结果最终纳入14个符合标准的研究,共1 838例病人,试验组共909例,对照组929例。试验组在以症状改善为疗效标准的方面,显效性、总有效性优于与对照组(P=0.000),有效性与对照组比较差异无统计学意义(P>0.05);在以心电图(ECG)改善为疗效标准的方面,显效性、总有效性优于对照组(P=0.000);有效性与对照组比较差异无统计学意义(P>0.05)。试验组在改善血流动力学指标、血脂、C反应蛋白、γ干扰素(INF-γ)、白介素-2(IL-2)水平,降低肌钙蛋白T(CTnT)、D-二聚体(D-Dimer),增加硝酸甘油减停量,减少血清同型半胱氨酸等方面优于对照组,差异具有统计学意义(P<0.05)。在改善外周静脉血白介素-4(IL-4)、白介素-10(IL-10)水平方面,试验组与对照组比较差异无统计学意义。不良反应:试验组出现头晕头胀2例(0.22%),皮疹1例(0.11%),发热感3例(0.33%),对照组无不良反应报道,两组均无明显肝肾损害。结论西药常规药物联合红花黄色素治疗不稳定型心绞痛,疗效优于西药常规治疗,并且能较单纯常规西药治疗更好的改善与心绞痛发作、缓解有关的多项指标,改善与预后相关的指标。

Objective To systematically evaluate the efficacy of safflower yellow and western medicine in the treatment of unstable an-gina.Methods Retrieved from database of Pubmed,Embase,Cochrane,Medline,CBM,CNKI,VIP,Wanfang and published beforeDecember2015,the clinical randomized controlled trials(RCTs)about the efficacy of safflower yellow and western medicine in thetreatment of unstable angina were collected.Two researchers screened out compliant RCTs independently according to inclusion andexclusion criteria and evaluate the score of the included studies and extracted data from these studies.Meta analysis was performedwith stata12.0software.Results A total of14RCTs met inclusion criteria.There were1838patients included909in experimentalgroup and929in controled.The patients in experimental group was treated with conventional western medicine and safflower yellow.The patients in controled group received the treatment of conventional western medicine.The excellence(treat the total number of ef-fectiveness and non effectiveness as number of non excellence)in experimental group was better than that in control group(P=0.000).Total effectiveness(consolidated the number of excellence and effectiveness as the number of total effectiveness)in experi-mental group was better than that in control group(P=0.000).There was no difference in The effectiveness(totaled number of ex-cellence and Ineffectiveness as the number of non effectiveness)between experimental group and control group(P>0.05).On theefficacy with electrocardiogram(ECG)as the standard,the excellence of experimental group was better than the control group(P=0.000).Total effectiveness of experimental group was better than the control group(P=0.000).There was no statistical significance inthe difference of effectiveness between experimental group and control group.The aspects of improving hemodynamics,blood lipids,C reactive protein,interferonγ(INFγ),interleukin2(IL2),interleukin4(IL4),interleukin10(IL10)levels of peripher-al venous blood,troponin T(CTnT),D dimer(D Dimer),homocysteine and increasing the amount of reducing and stopping of ni-troglycerin in experimental group were better than that in control group.The difference was statistically significant.There was no statis-tically significant difference in the aspect of improving IL4and IL10between the experimental and control groups(P>0.05).There were2cases of dizziness stretching(0.22%),1cases of rash(0.11%),3cases of feeling of fever(0.33%).There was no ad-verse reactions in the control group.There was no significantly liver or kidney damage in patients in two groups.Conclusion The effi-cacy of safflower yellow and western medicine is better than that of conventional western medicine treatment in patients with unstableangina,which can effectively improve the indexes of angina pectoris attacks,relieve a number of related indicators,improve the prog-nosis related indicators.Keywords:unstable angina