活血化瘀类口服中成药治疗高血压病左心室肥厚的网状Meta分析

Network Meta-analysis of oral blood-activating and stasis-removing Chinese patent medicines in treatment of hypertensive left ventricular hypertrophy

运用网状Meta分析比较活血化瘀类口服中成药治疗高血压病左心室肥厚(LVH)的疗效。计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、Cochrane Library数据库,检索时间为建库至2021年9月,搜集活血化瘀类口服中成药治疗高血压病LVH患者的临床随机对照试验(RCTs)。由2位研究者独立筛选文献、提取资料和评价文献,采用RevMan 5.3、Stata 15.1、ADDIS 1.16.8软件进行数据分析。最终纳入31项RCTs, 3 001例患者,涉及活血化瘀类口服中成药4种。网状Meta分析结果显示,改善心脏损害方面,中成药联合常规西药组的左心室质量指数(LVMI)均显著低于单纯常规西药组,而各中成药联合常规西药组组间的LVMI、左室射血分数(LVEF)、二尖瓣舒张早期与心房收缩期血流峰值的比值(E/A)均无显著差异,心脑舒通胶囊/片联合常规西药降低LVMI、提高LVEF的效果最好,心可舒胶囊/片联合常规西药提高E/A的效果最好;辅助控制血压方面,除通心络胶囊外其他中成药联合常规西药组的收缩压(SBP)、舒张压(DBP)均显著低于单纯常规西药组,心可舒胶囊/片联合常规西药降低SBP、DBP的效果最好,心脑舒通胶囊/片次之;安全性方面,所有研究均未发生严重不良反应。该研究所纳入的4种活血化瘀类口服中成药联合常规西药对高血压病LVH的疗效均显示出优势,心脑舒通胶囊/片联合常规西药为最优疗法的可能性最大。但受纳入文献数量和质量限制,该结论仍需更多高质量的多中心、大样本RCT予以验证。

This study was designed to assess the clinical efficacy of oral blood-activating and stasis-removing Chinese patent medicines in treating hypertensive left ventricular hypertrophy(LVH) based on network Meta-analysis. The clinical randomized controlled trials(RCTs) concerning the treatment of hypertensive LVH with oral blood-activating and stasis-removing Chinese patent medicines were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library from their inception to September 2021. Two researchers independently completed the literature screening, data extraction, and quality evaluation. The data were then analyzed by RevMan 5.3, Stata 15.1, and ADDIS 1.16.8. Finally, a total of 31 RCTs were included, involving 3 001 patients and four oral blood-activating and stasis-removing Chinese patent medicines. In terms of the alleviation of heart damage, the Chinese patent medicines combined with conventional western medicine groups were superior to the conventional western medicine groups in lo-wering the left ventricular mass index(LVMI). There was no significant difference in LVMI, left ventricular ejection fraction(LVEF), or the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity(E/A) between different Chinese patent medicines combined with conventional western medicine groups. Xinnao Shutong Capsules/Tablets combined with conventional western medicine had the best efficacy in reducing LVMI and elevating LVEF, while Xinkeshu Capsules/Tablets combined with conventional western medicine had the best effect in improving E/A. In the control of blood pressure, when all Chinese patent medicines except for Xinnao Shutong Capsules/Tablets were combined with conventional western medicine, the resulting systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower than those in the conventional western medicine group. Xinkeshu Capsules/Tablets combined with conventional western medicine produced the best effect in reducing SBP and DBP, followed by Xinnao Shutong Capsules/Tablets. In terms of safety, no serious adverse reactions occurred in all trials. The four oral blood-activating and stasis-removing Chinese patent medicines included in this study exhibited obvious advantages in the treatment of hypertensive LVH when they were combined with conventional western medicine, with the best effects observed in the Xinnao Shutong Capsules/Tablets combined with conventional western medicine group. However, due to the limitation of the quantity and quality of the included articles, the conclusion of this study still needs to be verified by more high-quality, multi-center, and large-sample RCTs.