柴胡加龙骨牡蛎汤治疗冠心病合并焦虑抑郁状态Meta分析及GRADE评价

Meta-analysis and GRADE Evaluation of Chaihu Jia Longgu Muli Decoction(柴胡加龙骨牡蛎汤)in the Treatment of Coronary Heart Disease Complicated with Depression and Anxiety

目的系统评价柴胡加龙骨牡蛎汤治疗冠心病合并焦虑抑郁状态的疗效与安全性,为临床提供循证依据。方法综合检索国内外CNKI、Sino Med、VIP、WanFang、PubMed、the Cochrane Library、Embase数据库建库至2020年6月,收集相关随机对照研究。由2名评价者独立完成文献筛选、提取信息,通过Rev Man 5.3软件进行评价,并按照GRADE标准进行证据质量评价。结果最终入选22项符合标准的研究,样本总计1528例,包括试验组764例,对照组764例,纳入研究总体质量一般。荟萃分析显示:柴胡加龙骨牡蛎汤试验组能提高心绞痛疗效[RR=1.29,95%CI(1.21,1.38),P<0.00001]与心电图疗效[RR=1.27,95%CI(1.11,1.46),P<0.00001],降低汉密尔顿焦虑量表(HAMA)评分[MD=-5.17,95%CI(-6.41,-3.94),P<0.00001]和汉密尔顿抑郁量表(HAMD)评分[MD=-3.46,95%CI(-4.14,-2.77),P<0.00001],改善中医症状疗效[RR=1.32,95%CI(1.17,1.48),P<0.00001],各项结局指标均优于对照组,且安全性较好。此外,亚组分析提示柴胡加龙骨牡蛎汤联合抗焦虑抑郁药在降低HAMA评分方面效果更加明确,GRADE证据评级显示结局指标的证据质量评级多为低级或极低级。结论临床应用柴胡加龙骨牡蛎汤可进一步改善心绞痛症状,缓解焦虑抑郁状态,且安全性较好,具有一定临床应用前景。

Objective To evaluate the clinical efficacy and safety of Chaihu Jia Longgu Muli Decoction(柴胡加龙骨牡蛎汤)in the treatment of coronary heart disease complicated with depression and anxiety,and to provide evidence-based reference for clinical treatment.Methods Databases of CNKI,Sino Med,VIP,Wan Fang,Pub Med,the Cochrane Library,Embase,were retrieved with computer for collecting the randomized controlled trials of Chaihu Jia Longgu Muli Decoction about the treatment of coronary heart disease complicated with depression and anxiety.Two reviewers independently completed the literature search and data extraction.The Rev Man 5.3 software which provided by Cochrane Collaboration Network was used for meta-analysis,and according to GRADE criteria,an evaluation of the quality of the evidence was conducted.Results A total of 22 studies involving 1528 patients were included,with 764 cases in treatment group and 764 case in control group.Meta-analysis results showed that the trial group of Chaihu Jia Longgu Muli Decoction could improve the efficacy of angina[RR=1.29,95%CI(1.21,1.38),P<0.00001]and the efficacy of ECG[RR=1.27,95%CI(1.11,1.46),P<0.00001],reduce HAMA scores[MD=-5.17,95%CI(-6.41,-3.94),P<0.00001]and HAMD scores[MD=-3.46,95%CI(-4.14,-2.77),P<0.00001],improve traditional Chinese medicine symptom effect[RR=1.32,95%CI(1.17,1.48),P<0.00001].All outcome indicators were better than the control group,and the safety was better.And subgroup analysis suggested that the effect of Chaihu Jia Longgu Muli Decoction combined with anti-anxiety and depression drugs on reducing HAMA scores was better.GRADE evidence rating showed that the evidence quality assessment of the outcome indicators was low or very low.Conclusion This study found that Chaihu Jia Longgu Muli Decoction can further improve clinical symptoms and relieve anxiety and depression,which has good safety and has certain clinical application prospects.