活血化瘀中药注射液治疗不稳定型心绞痛的网状Meta分析

Network Meta-analysis of Traditional Chinese Medicine Injection for Promoting Blood Circulation and Removing Blood Stasis in Unstable Angina

目的系统评价活血化瘀中药注射液联合常规西药治疗不稳定型心绞痛的有效性和安全性。方法计算机检索中国知网(CNKI)、万方数据库(WangFang Date)、维普数据库、EMbase、PubMed与The Cochrane Library中关于活血化瘀中药注射液联合常规西药治疗不稳定型心绞痛的随机对照试验(RCT),检索时限为各数据库建库至2021年3月31日。经过文献筛选,采用Cochrane系统评价员手册推荐的偏倚风险评估工具进行质量评价,使用R软件、JAGS软件和GEMTC软件包进行贝叶斯网状Meta分析。结果共纳入43项RCT,涉及4769例病人、8种中药注射液。网状Meta分析结果显示:与单纯西药治疗相比,银杏达莫注射液[OR=4.22,95%CrI(1.23,15.09)]、丹参酮ⅡA磺酸钠注射液[OR=8.66,95%CrI(2.13,42.18)]、丹参多酚酸盐注射液[OR=2.29,95%CrI(1.35,4.06)]、丹红注射液[OR=3.32,95%CrI(2.11,5.33)]、血塞通注射液[OR=5.58,95%CrI(2.15,15.66)]、舒血宁注射液[OR=3.57,95%CrI(1.72,7.53)]、大株红景天注射液[OR=4.14,95%CrI(1.83,9.77)]联合常规西药可提高心绞痛有效率;丹参酮ⅡA磺酸钠注射液[OR=4.45,95%CrI(1.26,17.36)]、丹参多酚酸盐注射液[OR=1.87,95%CrI(1.18,3.00)]、丹红注射液[OR=3.08,95%CrI(1.84,5.51)]、血塞通注射液[OR=5.88,95%CrI(2.15,18.24)]、舒血宁注射液[OR=2.59,95%CrI(1.24,5.84)]、大株红景天注射液[OR=3.23,95%CrI(1.75,6.25)]联合常规西药可提高心电图改善有效率;联合应用上述活血化瘀中药注射液,没有增加不良反应。结论现有证据表明:与单纯西药常规治疗相比,活血化瘀类中药注射液联合常规西药可进一步改善不稳定型心绞痛病人心电图缺血改变,减少心绞痛发作次数,缩短心绞痛持续时间,且不增加不良反应。

Objective To evaluate the efficacy and safety of traditional Chinese medicine injection for promoting blood circulation and removing blood stasis combined with conventional western medicine in the treatment of unstable angina pectoris.Methods CNKI,Wanfang database,VIP,EMbase,PubMed,and The Cochrane Library were searched to retrieve the randomized controlled studies about injection of Chinese medicine for promoting blood circulation and removing blood stasis combined with conventional western medicine in the treatment of unstable angina pectoris from the establishment of each database to March 31,2021.The literatures were screened,the basic characteristics of the included studies were extracted,and the bias risk assessment tool recommended by the Cochrane System Reviewer′s Manual was used for quality evaluation.R software,JAGS software,and GEMTC software package was used for Bayesian network Meta-analysis.Results A total of 43 randomized controlled trials were included,involving 4769 patients,8 kinds of traditional Chinese medicine injections.The results of the network Meta-analysis showed that,compared with the treatment of western medicine alone,the combined use of Ginkgo Damo injection[OR=4.22,95%CrI(1.23,15.09)],tanshinoneⅡA sodium sulfonate injection[OR=8.66,95%CrI(2.13,42.18)],salvia miltiorrhiza polyphenolate injection[OR=2.29,95%CrI(1.35,4.06)],Danhong injection[OR=3.32,95%CrI(2.11,5.33)],Xuesaitong injection[OR=5.58,95%CrI(2.15,15.66)],Shuxuening injection[OR=3.57,95%CrI(1.72,7.53)],Dazhu rhodiola injection[OR=4.14,95%CrI(1.83,9.77)]could improve the effective rate of angina.Conventional treatment combined with tanshinoneⅡA sodium sulfonate injection[OR=4.45,95%CrI(1.26,17.36)],salvia miltiorrhiza polyphenolate injection[OR=1.87,95%CrI(1.18,3.00)],Danhong injection[OR=3.08,95%CrI(1.84,5.51)],Xuesaitong injection[OR=5.88,95%CrI(2.15,18.24)],Shuxuening injection[OR=2.59,95%CrI(1.24,5.84)],Dazhu rhodiola injection[OR=3.23,95%CrI(1.75,6.25)]could improve the efficiency of ECG.Application of the Chinese medicine injection for promoting blood circulation and removing blood stasis mentioned above did not increase adverse reactions.Conclusion The available evidence suggests that compared with conventional medicine treatment alone,Chinese medicine injection for promoting blood circulation and removing blood stasis combined with conventional western medicine can further improve the ischemic electrocardiogram in patients with unstable angina pectoris,reduce the attacks of angina pectoris and the dosage of nitroglycerin,shorten the duration of angina pectoris without increasing adverse reactions as well.