6种益气活血类中成药治疗慢性心力衰竭的网状Meta分析

Network Meta-analysis of six Chinese patent medicines for replenishing Qi and activating blood in treatment of chronic heart failure

应用网状Meta分析对6种常用益气活血类中成药治疗慢性心力衰竭的疗效进行评价。计算机检索中国知网(CNKI)、万方(Wanfang)、中国生物医学文献服务系统(SinoMed)、PubMed、Cochrane Library,搜索有关益气活血类中成药治疗慢性心力衰竭的随机对照试验(RCTs)。采用Stata 16软件进行网状Meta分析。最终纳入154篇文献,15 620例患者,网状Meta分析显示,6种中成药联合常规西药与单纯常规西药治疗比较,临床总有效率累计概率排序为芪苈强心胶囊+常规西药>通心络胶囊+常规西药>芪参益气滴丸+常规西药>脑心通胶囊+常规西药>麝香通心滴丸+常规西药>养心氏片+常规西药>常规西药;左室射血分数(LVEF)累计概率排序为养心氏片+常规西药>麝香通心滴丸+常规西药>芪苈强心胶囊+常规西药>通心络胶囊+常规西药>芪参益气滴丸+常规西药>脑心通胶囊+常规西药>常规西药;N末端B型利钠肽原(NT-proBNP)累计概率排序为芪参益气滴丸+常规西药>养心氏片+常规西药>麝香通心滴丸+常规西药>芪苈强心胶囊+常规西药>通心络胶囊+常规西药>常规西药;左室舒张末期内径(LVEDD)累计概率排序为脑心通胶囊+常规西药>通心络胶囊+常规西药>麝香通心滴丸+常规西药>养心氏片+常规西药>芪苈强心胶囊+常规西药>芪参益气滴丸+常规西药>常规西药。结果提示,与单纯常规西药治疗相比,益气活血类中成药联合常规西药能明显提高临床总有效率,且可有效改善LVEF、NT-proBNP、LVEDD等心功能评价指标,值得临床推广使用。该研究结果可为气虚血瘀型慢性心力衰竭的中西医治疗提供临床选择参考和循证医学证据。

The efficacy of six commonly used Chinese patent medicines for replenishing Qi and activating blood in the treatment of chronic heart failure was evaluated systematically by network Meta-analysis. Randomized controlled trials(RCTs) about the treatment of chronic heart failure were searched against CNKI, Wanfang, SinoMed, PubMed, and Cochrane library. Network Meta-analysis was performed in Stata 16. A total of 154 RCTs involving 15 620 patients were eventually included. The network Meta-analysis showed that Qili Qiangxin Capsules+conventional western medicine had the highest total effective rate, followed by Tongxinluo Capsules+conventional western medicine, Qishen Yiqi Drop Pills+conventional western medicine, Naoxintong Capsules+conventional western medicine, Shexiang Tongxin Drop Pills+conventional western medicine, Yangxinshi Tablets+conventional western medicine, and conventional western medicine. As for left ventricular ejection fraction(LVEF), Yangxinshi Tablets+conventional western medicine had the highest value, followed by Shexiang Tongxin Drop Pills+conventional western medicine, Qili Qiangxin Capsules+conventional western medicine, Tongxinluo Capsules+conventional western medicine, Qishen Yiqi Drop Pills+conventional western medicine, Naoxintong Capsules+conventional western medicine, and conventional western treatments. As for N-terminal pro-B type natriuretic peptide(NT-proBNP), Qishen Yiqi Drop Pills+conventional western medicine was the most effective treatment, followed by Yangxinshi Tablets+conventional western medicine, Shexiang Tongxin Drop Pills+conventional western medicine, Qili Qiangxin Capsules+conventional western medicine, Tongxinluo Capsules+conventional western medicine, and conventional the most effective treatment was. As for left ventricular end-diastolic diameter(LVEDD), Naoxintong Capsules+conventional western medicine was the best therapy, followed by Tongxinluo Capsules+conventional western medicine, Shexiang Tongxin Drop Pills+conventional western medicine, Yangxinshi Tablets+conventional western medicine, Qili Qiangxin Capsules+conventional western medicine, Qishen Yiqi Drop Pills+conventional western medicine, and conventional western medicine. In summary, the combination of Chinese patent medicines for replenishing Qi and activating blood with western medicines is superior to conventional western medicine alone in the treatment of chronic heart failure. It effectively improves cardiac function indicators such as LVEF, NT-proBNP, and LVEDD, and thus is worthy of popularization in clinical practice. The results of this study provide evidence-based options for the clinical treatment of chronic cardiac failure by combining the Chinese patent medicines for replenishing Qi and activating blood with western medicine.