基于网状Meta分析方法评价医保目录中6种益气活血类中成药治疗冠心病心绞痛的疗效

Efficacy of Six Kinds of Yiqi Huoxue Chinese Patent Medicines in Medical Insurance Catalogue in the Treatment of Angina Pectoris of Coronary Heart Disease Based on Network Meta-Analysis

目的:基于网状Meta分析方法,评价医保目录中6种益气活血类中成药治疗冠心病心绞痛的疗效。方法:选取养心氏片、参松养心胶囊、芪参益气滴丸、脑心通胶囊、麝香保心丸和血栓心脉宁(片或胶囊)6种中成药,利用计算机检索中国知网、维普数据库、万方数据库和中国生物医学文献服务系统,以及PubMed和Web of Science,搜索上述6种中成药分别联合常规西药治疗对比单独采用常规西药治疗用于冠心病心绞痛的随机对照试验,检索时限为数据库建立至2022年6月12日。下载全文、提取文献数据并进行质量评价后,采用Stata 15.1及R 4.0.3软件进行统计分析。结果:共纳入87项研究。网状Meta分析结果显示,在心绞痛疗效方面,累积概率排序为养心氏片+常规西药>参松养心胶囊+常规西药>芪参益气滴丸+常规西药>脑心通胶囊+常规西药>血栓心脉宁(片或胶囊)+常规西药>麝香保心丸+常规西药>常规西药;在心电图疗效方面,累积概率排序为养心氏片+常规西药>芪参益气滴丸+常规西药>脑心通胶囊+常规西药>血栓心脉宁(片或胶囊)+常规西药=参松养心胶囊+常规西药>麝香保心丸+常规西药>常规西药。综合2个结局指标,养心氏片+常规西药的疗效最好,其次为芪参益气滴丸+常规西药。结论:以常规西药治疗为基础,分别联合使用6种益气活血类中成药治疗冠心病心绞痛均能显著提高疗效,其中养心氏片联合常规西药治疗效果最佳。但因纳入文献数量及质量方面的局限性,该结论还需开展更多高质量研究来验证。

OBJECTIVE:To evaluate the efficacy of six kinds of Yiqi Huoxue Chinese patent medicines in medical insurance catalogue in the treatment of angina pectoris of coronary heart disease based on network Meta-analysis.METHODS:Six kinds of Chinese patent medicines including Yangxinshi tablets,Shensong Yangxin capsules,Qishen Yiqi dropping pills,Naoxintong capsules,Shexiang Baoxin pills,Xueshuan Xinmaining(tablets or capsules)were selected.CNKI,VIP,Wanfang Data,SinoMed,PubMed and Web of Science were retrieved to collect the randomized controlled trial of the six kinds of Chinese patent medicines combined with conventional western medicine versus conventional western medicine alone in the treatment of angina pectoris of coronary heart disease.The retrieval time was from the establishment of the database to Jun.12th,2022.After downloading the full text,extracting the data and evaluating the quality of the literature,Stata 15.1 and R 4.0.3 software were used for statistical analysis.RESULTS:A total of 87 studies were included.Network Meta-analysis showed that the cumulative probability order of angina pectoris efficacy was Yangxinshi tablets+conventional western medicine>Shensong Yangxin capsules+conventional western medicine>Qishen Yiqi dropping pills+conventional western medicine>Naoxintong capsules+conventional western medicine>Xueshuan Xinmaining(tablets or capsules)+conventional western medicine>Shexiang Baoxin pills+conventional western medicine>conventional western medicine.In terms of ECG efficacy,the order of cumulative probability was Yangxinshi tablets+conventional western medicine>Qishen Yiqi dropping pills+conventional western medicine>Naoxintong capsules+conventional western medicine>Xueshuan Xinmaining(tablets or capsules)+conventional western medicine=Shensong yangxin capsules+conventional western medicine>Shexiang Baoxin pills+conventional western medicine>conventional western medicine.According to the two outcome indicators,Yangxinshi tablets+conventional western medicine were the best,followed by Qishen Yiqi dropping pills and Naoxintong capsules.CONCLUSIONS:On the basis of conventional western medicine treatment,the combined use of six kinds of Yiqi Huoxue Chinese patent medicines in the treatment of angina pectoris can significantly improve the curative efficacy,and the therapeutic efficacy of Yangxinshi tablets combined with western medicines is significant.However,due to the limitations of the quantity and quality of the final included literature,the conclusion of the study needs to be further validated by more high-quality studies.