瓜蒌薤白白酒汤加减治疗冠心病心绞痛随机对照试验的Meta分析

Meta-analysis of the Randomized Controlled Trials in Treating Angina Pectoris of Coronary Heart Disease with Modified Gualou Xiebai Baijiu Decoction

目的:系统评价瓜蒌薤白白酒汤加减治疗冠心病心绞痛的疗效及其对血脂水平、血液流变学的影响。方法:计算机检索中国知网(CNKI)、万方(WanFang Data)、维普(VIP)、中国生物医学文献数据库(CBM)、the Cochrane Library、PubMed、EMbase、Web of Science数据库,检索时限为建库至2021年4月30日。由2名研究者独立筛选文献、提取资料,并评价偏倚风险,采用RevMan 5.3软件进行Meta分析。结果:共纳入16项研究,包括1491例病人。Meta分析结果显示:与其他治疗相比,瓜蒌薤白白酒汤的临床总疗效[OR=5.13,95%CI(3.55,7.40),P<0.00001]及心电图改善情况[OR=3.07,95%CI(1.76,5.33),P<0.00001]更好;心绞痛发作频率[SMD=-1.90,95%CI(-2.15,-1.65),P<0.00001]、心绞痛持续时间[SMD=-2.44,95%CI(-3.09,-1.78),P<0.00001]更低;总胆固醇(TC)[MD=-1.19,95%CI(-1.73,-0.64),P<0.0001]、三酰甘油(TG)[MD=-0.59,95%CI(-0.75,-0.43),P<0.00001]、低密度脂蛋白胆固醇(LDL-C)[MD=-0.92,95%CI(-1.26,-0.58),P<0.00001]水平明显降低,高密度脂蛋白胆固醇(HDL-C)水平[SMD=1.34,95%CI(0.37,2.31),P=0.007]明显升高;全血高切黏度[MD=-1.01,95%CI(-1.24,-0.79),P<0.00001]、全血低切黏度[MD=-1.98,95%CI(-2.28,-1.68),P<0.00001]、血浆黏度[MD=-0.31,95%CI(-0.41,-0.22),P<0.00001]、纤维蛋白原水平[MD=-0.85,95%CI(-0.93,-0.78),P<0.00001]均降低。结论:现有证据表明,瓜蒌薤白白酒汤治疗冠心病心绞痛的疗效较好,可有效改善血脂水平及血液流变学状态,推荐联合使用。上述结论仍需更多高质量研究予以验证,并对其安全性进行补充分析。

Objective:To evaluate the efficacy of Gualou Xiebai Baijiu Decoction in the treatment of angina pectoris of coronary heart disease and its effect on blood lipid level and hemorheology.Methods:The databases of CNKI,WanFang Data,VIP,Chinese Biomedical Literature Database(CBM),the Cochrane Library,PubMed,EMbase,and Web of Science were retrieved with computer.The retrieving time limit was from database establishment to April 30,2021.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias.Meta-analysis was conducted by RevMan 5.3 software.Results:A total of 16 randomized controlled trials with 1491 patients were included.The results of Meta analysis showed that,compared with other therapies,the total efficacy[OR=5.13,95%CI(3.55,7.40),P<0.00001]and electrocardiograph(ECG)improvement[OR=3.07,95%CI(1.76,5.33),P<0.00001]of Gualou Xiebai Baijiu Decoction were better,the frequency of angina attacks[SMD=-1.90,95%CI(-2.15,-1.65),P<0.00001],angina pectoris duration[SMD=-2.44,95%CI(-3.09,-1.78),P<0.00001]was lower,the levels of total cholesterol(TC)[MD=-1.19,95%CI(-1.73,-0.64),P<0.0001],triglyceride(TG)[MD=-0.59,95%CI(-0.75,-0.43),P<0.00001]and low-density lipoproteincholesterol(LDL-C)[MD=-0.92,95%CI(-1.26,-0.58),P<0.00001]were decreased significantly,the level of high-density lipoproteincholesterol(HDL-C)[SMD=1.34,95%CI(0.37,2.31),P=0.007]were increased significantly,the whole blood high shear viscosity[MD=-1.01,95%CI(-1.24,-0.79),P<0.00001],whole blood low shear viscosity[MD=-1.98,95%CI(-2.28,-1.68),P<0.00001],blood plasma viscosity[MD=-0.31,95%CI(-0.41,-0.22),P<0.00001],and fibrinogen level[MD=-0.85,95%CI(-0.93,-0.78),P<0.00001]were lower.Conclusion:Available evidence suggests that Gualou Xiebai Baijiu Decoction shows significant curative effect on angina pectoris of coronary heart disease,and can effectively improve the level of blood lipid and hemorheology state.The above conclusions still need to be verified by more high-quality studies and analysis.