含水蛭中成药治疗动脉粥样硬化的网状Meta分析

Network Meta-analysis of Chinese patent medicine containing Hirudo in treatment of atherosclerosis

采用网状Meta分析评价含水蛭中成药干预动脉粥样硬化的疗效及安全性,为动脉粥样硬化的临床治疗提供循证依据。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、EMbase等,搜索有关含水蛭中成药干预动脉粥样硬化的随机对照试验(randomized controlled trial,RCT),检索时限为各数据库建库至2022年7月1日。采用Cochrane推荐的偏倚风险评估工具对纳入的RCT进行质量评价。应用Stata 17软件和ADDIS 1.16.5软件进行贝叶斯模型网状Meta分析。最终纳入67项RCTs,总样本量6826例,其中试验组3569例,对照组3257例,共纳入3种口服中成药。网状Meta分析结果表明,在降低动脉内膜-中层厚度(IMT)方面,排序前3的干预措施为通心络胶囊+他汀类>脉血康胶囊+他汀类>脉血康胶囊;在降低斑块面积方面,脉血康胶囊+他汀类为排序第1的干预措施,其余疗效相当;在降低斑块积分方面,排序前3的干预措施为脉血康胶囊>通心络胶囊+他汀类>脑心通胶囊;在降低斑块数量方面,排序前3的干预措施为脑心通胶囊+他汀类>通心络胶囊+他汀类>通心络胶囊;在不良反应发生方面,发生率最低的干预措施为脑心通胶囊+他汀类。含水蛭中成药治疗动脉粥样硬化的方案中,在降低IMT方面首选通心络胶囊+他汀类,在降低斑块积分方面首选脉血康胶囊,在降低斑块面积方面首选脉血康胶囊+他汀类,在降低斑块数量方面首选脑心通胶囊+他汀类。对于4项结局指标,含水蛭中成药联合或不联合他汀类均比单独口服他汀类效果好。因此,动脉粥样硬化的治疗应当综合评估,注重中成药联合化学药的应用,以治疗效果最佳化及不良反应最小化为基准。

This study aimed to evaluate the efficacy and safety of Chinese patent medicines containing Hirudo in the treatment of atherosclerosis(AS)by network Meta-analysis,and to provide evidence-based reference for clinical treatment of AS.The clinical randomized controlled trial(RCT)on the treatment of atherosclerosis with Chinese patent medicines containing Hirudo were searched in CNKI,Wanfang,VIP,SinoMed,PubMed and EMbase from the establishment of the databases to July 1,2022.And data extraction and quality assessment of the included RCT was performed according to the Cochrane standards.Stata 17 and ADDIS 1.16.5 were then used for Bayesian model network Meta-analysis.Finally,67 RCTs with a total sample size of 6826 cases were included,3569 cases in the experimental group and 3257 cases in the control group,involving three oral Chinese patent medicines.Network Meta-analysis showed that in terms of reducing intima-media thickness(IMT),the top three Chinese patent medicines were Tongxinluo Capsules+sta-tins>Maixuekang Capsules+statins>Maixuekang Capsules.In terms of reducing plaque area,the top one was Maixuekang Capsules+sta-tins,and the other Chinese patent medicines had similar efficacy.For lowering AS Crouse scores,the top three were Maixuekang Capsules>Tongxinluo Capsules+statins>Naoxintong Capsules.For decreasing plaque number,the top three were Naoxintong Capsules+sta-tins>Tongxinluo Capsules+statins>Tongxinluo Capsules.With regard to adverse reactions/events,Naoxintong Capsules+statins had the lo-west incidence.In conclusion,in Chinese patent medicines containing Hirudo for the treatment of AS,Tongxinluo Capsules+statins,Maixuekang Capsules,Maixuekang Capsules+statins,and Naoxintong Capsules+statins were the primary choices to reduce IMT,AS Crouse scores,plaque area,and plaque number,respectively.The efficacy of Chinese patent medicines containing Hirudo with or without statins was more significant than that of statins alone in the four outcome indexes.Additionally,the treatment of AS should be evaluated comprehensively,and attention should be paid to Chinese patent medicines or their combination with western medicine,to optimize the treatment effect and minimize adverse reactions as the benchmark.