麝香保心丸联合常规西药改善冠心病不稳定型心绞痛研究的系统评价

Systematic Evaluation on the Improvement of Shexiang Baoxin Pills Combined with Conventional Western Medicine on Unstable Angina Pectoris of Coronary Heart Disease

目的基于系统评价,对麝香保心丸联合常规西药对冠心病不稳定型心绞痛的改善及疗效进行Meta分析。方法利用计算机检索文献数据库,包括中国知网(CNKI)、万方数据库(WanFang)、维普数据库(VIP)、中国生物医学文献数据库(CBMdisc)、PubMed数据库、Cochrane数据库自建库至2019年12月发表的关于麝香保心丸联合常规西药改善冠心病不稳定型心绞痛的随机临床对照试验研究(RCT),同时进行质量评价及有效资料提取,运用Cochrane协作网提供的RevMan5.3软件进行统计学分析。结果共纳入合格RCT研究37个,受试者4104例,其中试验组2081例,对照组2023例。Meta分析结果显示:与单纯常规西药治疗比较,联用麝香保心丸可进一步减少不稳定型心绞痛患者心绞痛发作次数(P<0.01)[SMD=-2.00,95%CI(-2.78,-1.21)];心绞痛持续时间(P<0.01)[SMD=-2.42,95%CI(-3.78,-1.06)];心电图改善显著,具有统计学意义[RR=1.26,95%CI(1.20,1.32)];分析全部RCT的整体有效率具有统计学意义(P<0.01)[RR=1.20,95%CI(1.17,1.23)]。结论与常规西药治疗冠心病不稳定型心绞痛比较,麝香保心丸联合常规西药能一步提高疗效,但鉴于纳入临床研究在质量上存在一定局限性,部分RCT严谨性得出结果仅作为临床诊疗的循证参考,还需更多高质量的RCT进一步证实其疗效。

Objective:To make a meta-analysis about the improvement and efficacy of Shexiang Baoxin Pills combined with conventional Western medicine on unstable angina pectoris of coronary heart disease,based on systematic evaluation.Methods:Computers were used to retrieve literature database,including CNKI,WanFang,VIP,CBMdisc,PubMed database and Cochrane database for the RCTs about Shexiang Baoxin Pills with conventional Western medicine on unstable angina pectoris of coronary heart disease published from database establishment to December 2019.The quality was evaluated and the effective information was extracted.RevMan5.3 software from Cochrane was used for statistical analysis.Results:37 qualified RCTs were included,with 4104 subjects,including 2081 in the experimental group and 2023 in the control group.The results of meta-analysis showed that compared with conventional Western medicine alone,the combination of Shexiang Baoxin Pills could further reduce the number of angina pectoris attacks in patients with unstable angina pectoris[SMD=-2.00,95%CI(-2.78,-1.21)(P<0.01)]and angina duration[SMD=-2.42,95%CI(-3.78,-1.06)(P<0.01)].The improvement of ECG was statistically significant[RR=1.26,95%CI(1.20,1.32)].The overall effective rate of all RCTs was analyzed with statistical significance[RR=1.20,95%CI(1.17,1.23)(P<0.01)].Conlusion:Compared with conventional Western medicine treatment of coronary heart disease unstable angina,Shexiang Baoxin Pills combined with conventional Western medicine can step to improve curative effect.However,there are some limitations in the quality of clinical research.The results of some RCT tests are only used as evidence-based reference for clinical diagnosis and treatment,and more high-quality RCTs are needed to further confirm its efficacy.