活血化瘀法联合常规疗法治疗脑心综合征的Meta分析

Meta-analysis of Treating Cerebral-cardiac Syndrome by Blood-activating Stasis-removing Method and Conventional Therapy

目的:系统评价活血化瘀法联合现代医学常规疗法治疗脑心综合征(cerebral-cardiac syndrome,CCS)的疗效及安全性。方法:计算机检索CNKI、WanFang Data、CBM、PubMed、EMbase数据库,搜集中英文公开发表的关于联合中医活血化瘀法治疗脑心综合征的随机对照试验,检索时限从建库至2020年8月。采用Rev-man 5.3软件对纳入研究的患者临床疗效、心电图指标、神经功能缺损评分及安全性进行Meta分析。结果:共纳入25项研究,共2936例受试者,其中联合活血化瘀法研究组1459例,对照组1477例。与对照组相比,研究组临床疗效更显著(RR=1.26,95%CI[1.21,1.30],P<0.00001)。研究组心电图指标:心律失常率(RR=0.41,95%CI[0.32,0.52],P<0.00001),ST-T异常率(RR=0.34,95%CI[0.27,0.42],P<0.00001),心肌酶水平(RR=0.37,95%CI[0.21,0.66],P=0.0008)有更明显的改善;心功能水平(RR=0.40,95%CI[0.16,1.00],P=0.05)未见明显差异。研究组神经功能缺损评分(MD=-4.43,95%CI[-6.27,-2.59],P<0.00001)改善但异质性高。在安全性方面,研究组不良反应发生率均低于对照组。结论:中医活血化瘀法联合常规疗法治疗CCS能够提高临床有效性,改善患者的心电图指标及心肌酶水平,在改善心脏功能方面获益,且可能降低不良事件发生率,但神经功能方面是否获益有待进一步研究。

Objective:To systematically evaluate clinical effects of blood-activating stasis-removing method and conventional therapy of modern medicine in the treatment of CCS and its safety.Methods:Randomized controlled trials published in Chinese and English on the treatment of CCS combined with TCM blood-activating method were collected from CNKI,Wanfang data,CBM,PubMed and EMbase databases using computer,and retrieval time limit was from the establishment of the database to August 2020.Software Revman 5.3 was used to perform the meta analysis of clinical effects for the patients included in the study,ECG indexes,neurological deficit score and safety.Results:A total of 25 studies were included,involving 2936 subjects,among which,1459 cases in the study group of combined method of blood-activating stasis-removing and 1477 cases in the control group.Compared with the control group,clinical effects of the study group was more notable(RR=1.26,95%CI[1.21,1.30],P<0.00001).ECG indexes of the study group:arrhythmia rate(RR=0.41,95%CI[0.32,0.52],P<0.00001),ST-T abnormal rate(RR=0.34,95%CI[0.27,0.42],P<0.00001),myocardial enzyme level(RR=0.37,95%CI[0.21,0.66],P=0.0008),showed more obvious improvements;cardiac function level(RR=0.40,95%CI[0.16,1.00],P=0.05)indicated no obvious difference.Neurological deficit score(MD=-4.43,95%CI[-6.27,-2.59],P<0.00001)of the study group was improved but highly heterogeneous.As for the safety,the study group was lower than the control group in the incidence of adverse reaction.Conclusion:TCM blood-activating stasis removing method and conventional therapy in the treatment of CCS could lift clinical effectiveness,improve ECG indexes and myocardial enzyme level,it is beneficial in improving cardiac function and may reduce the incidence of adverse events,but whether it is beneficial in neurological function remains to be further studied.