不同活血化瘀类中成药注射液联合常规治疗用于PCI术后疗效与安全性的贝叶斯网状Meta分析

Bayesian Network Meta-analysis of Therapeutic Efficacy and Safety of Different Chinese Patent Medicine Injection for Promoting Blood Circulation and Removing Blood Stasis Combined with Routine Treatment after PCI

目的:系统评价不同活血化瘀类中成药注射液联合常规治疗用于经皮冠状动脉介入(PCI)术后疗效、安全性、心功能的差异,为临床用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国知网数据库、万方数据库、中文科技期刊数据库,收集不同活血化瘀类中成药注射液联合常规治疗(试验组)对比常规治疗(对照组)用于PCI术后的随机对照试验(RCT)。筛选文献,提取资料后采用改良Jadad量表对纳入研究质量进行评价,采用Stata 14.0软件及马尔科夫链-蒙特卡洛方法进行贝叶斯网状Meta分析。结果:共纳入15项RCT,共计1 364例患者,涉及丹参注射液、葛根素注射液、益气复脉注射液、血必净注射液、参附注射液、疏血通注射液、丹参川芎嗪注射液、大株红景天注射液、丹红注射液等9种干预措施(中成药注射液)。Meta分析结果显示,在提高心电图总有效率方面,共涉及8种干预措施,与对照组比较,试验组除参附注射液(P>0.05)外,其余7种干预措施均可提高心电图总有效率,网状Meta排序结果为丹参注射液>葛根素注射液>参附注射液>丹参川芎嗪注射液>疏血通注射液>大株红景天注射液>丹红注射液>常规治疗。在降低不良心血管事件(MACE)发生率方面,共涉及8种干预措施,与对照组比较,试验组除葛根素注射液(P>0.05)外,其余7种干预措施均可降低MACE发生率,网状Meta排序结果为丹参川芎嗪注射液>丹红注射液>血必净注射液>疏血通注射液>丹参注射液>大株红景天注射液>葛根素注射液>常规治疗。在改善治疗后左心室射血分数(LVEF)方面,共涉及8种干预措施,与对照组比较,试验组除大株红景天注射液(P>0.05)外,其余7种干预措施均可改善治疗后LVEF,网状Meta排序结果为丹参川芎嗪注射液>益气复脉注射液>丹红注射液>参附注射液>丹参注射液>疏血通注射液>大株红景天注射液>常规治疗。结论:与常规治疗相比,在提高心电图总有效率方面,丹参注射液效果最佳,在降低MACE发生和改善治疗后LVEF方面,丹参川芎嗪注射液效果最佳。

OBJECTIVE:To systematically evaluate the difference in therapeutic efficacy,safety and cardiac function of Chinese patent medicine injection for promoting blood circulation and removing blood stasis combined with routine treatment after percutaneous coronary intervention(PCI),and to provide evidence-based reference for clinical drug use. METHODS:Retrieved from Cochrane library,PubMed,Embase,CNKI,Wanfang database and Chinese sci-tech periodicals database,RCTs about different Chinese patent medicine injection for promoting blood circulation and removing blood stasis combined with routine treatment(trial group)versus routine treatment(control group)after PCI were collected. After screening the literature and extracting the data,the quality of the included studies was evaluated by modified Jadad scale. Bayesian network Metaanalysis was performed by using Stata 14.0 software and Markov Chain-Monte Carlo method. RESULTS:A total of 15 RCTs involving 1 364 patients were included,involving Salvia miltiorrhiza injection,Puerarin injection,Yiqi fumai injection,Xuebijing injection,Shenfu injection,Shuxuetong injection,Salvia miltiorrhiza and ligustrazine injection,Rhodiola wallichiana injection,Danhong injection. Results of Meta-analysis showed that in the aspect of improving total response rate of ECG,8 kinds of intervention measures were involved;compared with control group,7 kinds of intervention measures could improve the total response rate of ECG of trial group except for Shenfu injection(P>0.05);network Meta-analysis ranking showed that S. miltiorrhiza injection>Puerarin injection>Shenfu injection>S. miltiorrhiza and ligustrazine injection>Shuxuetong injection>R. wallichiana injection> Danhong injection>routine treatment. In terms of reducing adverse cardiovascular events(MACE)incidence,8 kinds of intervention measures were involved;compared with control group,7 kinds of intervention measures could reduce the MACE incidence of trial group except for Puerarin injection(P>0.05);network Meta-analysis ranking showed that S. miltiorrhiza and ligustrazine injection>Danhong injection>Xuebijing injection>Shuxuetong injection>S. miltiorrhiza injection>R. wallichiana injection> Puerarin injection>routine treatment. In terms of improving left ventricular ejection fraction(LVEF)after treatment,8 kinds of intervention measures were involved;compared with control group,7 intervention measures could significantly improve LVEF after treatment of trial group except for R. wallichiana injection(P>0.05);network Meta-analysis ranking showed that S. miltiorrhiza and ligustrazine injection>Yiqi fumai injection>Danhong injection>Shenfu injection>S. miltiorrhiza injection>Shuxuetong injection>R. wallichiana injection>routine treatment.CONCLUSIONS:Compared with routine treatment,S. miltiorrhiza injection is the best in improving total response rate of ECG;S. miltiorrhiza and ligustrazine injection is the best in reducing MACE incidence and improving LVEF after treatment.