中西医结合防治冠脉支架再狭窄疗效及安全性的Meta分析

Meta-analysis of the Efficacy and Safety of Integrated Traditional Chinese and Western Medicine in the Prevention and Treatment of Coronary Stent Restenosis

目的通过Meta分析系统评价中西医结合防治冠脉支架再狭窄的临床疗效。方法计算机检索中国知网全文数据库、维普中文科技期刊全文数据库,万方数据知识服务平台、中国生物医学文献数据库、PubMed、Cochrane Library数据库并手工检索相关文献,检索年限为数据库建库至2020年2月,由2位研究人员独立检索,筛选文献,并根据Cochrane系统评价方法学对纳入的文献进行资料提取和质量评价,采用RevMan5.3软件进行Meta分析。结果共检索文献105篇,根据纳入和排除标准,本次研究共纳入12篇文献,采用固定效应模型进行总效应值合并,结果在各个结局指标中西医结合治疗冠脉支架再狭窄优于单纯西医治疗。12篇文献中医证候有效率合并[RR=4.29,95%CI(2.91,6.34),Z=7.34,P<0.05];12篇文献支架再狭窄支数有效率合并[RR=0.21,95%CI(0.14,0.31),Z=7.47,P<0.05];其中5篇文献心电图疗效有效率合并[RR=3.16,95%CI(1.97,5.07),Z=4.78,P<0.05];有2篇文献对术后复发心绞痛情况进行了描述,有效率[RR=0.26,95%CI(0.11,0.60),Z=3.15,P<0.05];有3篇文献对中医证候积分情况进行了描述[SMD=-1.82,95%CI(-3.13,-0.50),Z=2.71,P<0.05];有2篇文献对血瘀积分情况进行了描述[MD=-3.86,95%CI(-6.54,-1.18),Z=2.82,P<0.05];漏斗图显示左右基本对称,提示发表偏倚较小。结论在防治上,中西医结合优于单纯西医治疗,临床上对于冠脉支架植入术后患者应多采用中西医结合方式防止支架再狭窄,充分发挥中西医结合的优势。但由于纳入文献局限性较强,该Meta分析结果也存在相应局限性,故需用更多高质量的RCT进一步深入研究。

Objective:To evaluate the clinical efficacy of integrated traditional Chinese and western medicine in the prevention and treatment of coronary stent restenosis through a meta-analysis system.Methods:The Jour⁃nal Full-text Database,VIP Chinese Science and Technology Periodicals Full-text Database,Wanfang Data Knowl⁃edge Service Platform,China Biomedical Literature Database,PubMed,Cochrane Library were searched by the computer and the related literatures were manually retrieved.The search period was from the inception to Febru⁃ary 2020.Two researchers independently searched and screened the literatures and performed data extraction and quality evaluation on the included literatures according to the Cochrane systematic review methodology.Meta-anal⁃ysis was performed using RevMan5.3 software.Results:A total of 105 Chinese literatures were retrieved.Accord⁃ing to the inclusion and exclusion criteria,a total of 12 literatures were included in this study.The total effect val⁃ue was combined using a fixed effect model.Results in the treatment of coronary artery stent restenosis showed that the combination of traditional Chinese and western medicine was superior to the western medicine alone in all outcome indicators.12 articles with TCM syndrome effective rate combined with[RR=4.29,95%CI(2.91,6.34),Z=7.34,P<0.05];12 articles with effective stent restenosis count combined with[RR=0.21,95%CI(0.14,0.31),Z=7.47,P<0.05];5 articles combined ECG efficacy with[RR=3.16,95%CI(1.97,5.07),Z=4.78,P<0.05];2 ar⁃ticles described the postoperative recurrence of angina pectoris,the effective rate was[RR=0.26,95%CI(0.11,0.60),Z=3.15,P<0.05];3 articles described the TCM syndrome scores,with[SMD=-1.82,95%CI(-3.13,-0.50),Z=2.71,P<0.05];2 articles describing the blood stasis score with[MD=-3.86,95%CI(-6.54,-1.18),Z=2.82,P<0.05];the funnel diagram showed that the left and right sides were basically symmetrical,sug⁃gesting that the publication bias was small.Conclusion:In prevention and treatment,the combination of tradition⁃al Chinese and western medicine is superior to the treatment of western medicine alone.Clinically,for patients af⁃ter coronary stent implantation,the combination of traditional Chinese and western medicine should be used to pre⁃vent the restenosis of the stent,and the advantages of combining traditional Chinese and western medicine should be brought into full play.However,due to the limitations of the included literature,the results of this meta-analy⁃sis also have corresponding limitations.Therefore,more high-quality RCTs are needed for further in-depth re⁃search.