基于网状Meta分析的补益类中药注射剂治疗急性心肌梗死临床评价研究

Comparative Efficacy of Tonic Class Chinese Herbal Injections for Treating Acute Myocardial Infarction: a Network Meta-analysis

目的:采用贝叶斯网状Meta分析方法对补益类中药注射剂联合西医常规用药方案治疗急性心肌梗死的有效性及安全性进行分析。方法:计算机检索Embase、The Cochrane library、PubMed、CNKI、WanFang Data、VIP、SinoMed数据库,搜集补益类中药注射剂联合西医常规用药治疗急性心肌梗死的随机对照试验(RCT),检索时限均为建库至2018年8月8日。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险。患者在临床总有效率、静脉溶栓再通率、胸痛缓解、ST段回降、心肌酶峰提前、再灌注心律失常方面的改善通过Winbugs 1.4.3软件、Stata 13.0软件进行分析,并用Stata 13.0软件绘图。结果:共纳入27个RCTs,2445例患者。通过网状Meta分析的疗效排序结果及聚类分析结果,纳入的中药注射剂联合西医常规用药方案疗效均优于单纯使用西医常规用药,其中,黄芪注射剂在临床总有效率方面疗效较好,生脉注射剂在其他方面疗效较好。结论:针对急性心肌梗死,在西医常规用药方案的基础上,分别联用黄芪、生脉注射剂较其他注射剂有效。但还需更多高质量的临床随机对照试验支持本次研究所得结论。

Objective:To access the efficacy and safety of tonic class Chinese herbal injections(CHIs)combined western medicine treatment(WM)for treating acute myocardial infarction via network meta-analysis.Methods:Embase,The Cochrane Library,PubMed,CNKI,WanFang Data,VIP,SinoMed database were electronically searched to collect randomized controlled trial(RCT)of tonic class CHIs combined WM for treating acute myocardial infarction from inception to August 8 th 2018.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.The improvement of the clinical effectiveness rate,the rate of venous thrombolysis and recanalization,chest pain relief occurance,reduction in ST-segment elevation occurance,advanced peak of myocardial enzyme occurance and reperfusion arrhythmia occurance were estimated by Winbugs 1.4.3 software and Stata 13.0 software.Meanwhile,the relevant figures were displayed by Stata 13.0.Results:A total of 27 RCTs involving 2245 patients were included.The network Meta-analysis results demonstrated that all eligible tonic class CHIs plus WM were superior to WM alone.And Huangqi injection plus WM attained the first rank in the clinical effectiveness rate,and Shenmai plus WM had better impact on the others.Conclusion:In conclusion,on the basis of WM,Huangqi injection and Shenmai injection may be a perforable treatment in acute myocardial infarction than others.In terms of insufficient of this study,more high quality RCTs needed to implement to support our conclusions.