益气活血法配伍治疗冠心病经皮冠脉介入术后再发心绞痛临床疗效的Meta分析

Clinical Efficacy of Qi-benefiting and Blood-activating Therapy for Recurrent Angina Pectoris after PCI for Coronary Heart Disease:A Meta-analysis

目的:系统评价益气活血法配伍治疗冠心病经皮冠脉介入术(PCI)术后再发心绞痛的临床疗效。方法:检索2021年12月之前国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)及中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、PubMed、Web of Science等数据库,收集益气活血法配伍治疗冠心病PCI术后再发心绞痛的随机对照试验(RCT),借助Cochrane和改良后的Jadad量表评价文献质量,运用RevMan 5.3、Stata16软件进行Meta分析。结果:共纳入20篇文献,1 412例患者。益气活血法配伍联合术后西医常规治疗与单纯西药治疗比较,可显著提高临床总有效率(OR=3.60,95%CI为2.14~6.04,P<0.000 01)、心绞痛疗效(OR=4.25,95%CI为2.79~6.45,P<0.000 01)、中医证候疗效(OR=4.38,95%CI为2.97~6.45,P<0.000 01)、心电图疗效(OR=2.47,95%CI为1.56~3.90,P=0.000 1),减少心绞痛发作次数(MD=-0.39,95%CI为-0.75~-0.02,P=0.04),降低总胆固醇(MD=-0.35,95%CI为-0.55~-0.15,P=0.000 6)、低密度脂蛋白胆固醇(MD=-0.37,95%CI为-0.53~-0.21,P<0.000 01)、超敏C反应蛋白(MD=-1.41,95%CI为-2.05~-0.76,P<0.000 1)、左室射血分数(OR=1.47,95%CI为0.54~2.40,P=0.002),但而对中医证候积分(MD=-2.43,95%CI为-5.83~0.96,P=0.16)和心绞痛发作持续时间(MD=-0.44,95%CI为-1.18~0.30,P=0.24)水平的改善,与对照组无明显差异。结论:益气活血法配伍治疗可以进一步提高冠心病PCI术后再发心绞痛患者的临床疗效且具有良好的安全性。

Objective:To systematically evaluate the clinical efficacy of qi-benefiting and blood-activating therapy in the treatment of recurrent angina pectoris after percutaneous coronary intervention(PCI)for coronary heart disease.Methods:CNKI,CSPD,CCD,CBM,PubMed,and Web of Science were searched for randomized controlled trials(RCTs)on qi-benefiting and blood-activating therapy in the treatment of recurrent angina pectoris after PCI for coronary heart disease from database inception to December 2021.The Cochrane risk-of-bias tool and the modified Jadad scale were used to evaluate the quality of the included studies.Meta-analysis was performed using RevMan 5.3 and Stata16.0 software.Results:Twenty RCTs were included,with 1412 patients involved.The results of Meta-analysis showed that compared with western medicine alone,qi-benefiting and blood-activating therapy combined with western medicine could significantly improve the clinical total effective rate(OR=3.60,95%CI 2.14 to 6.04,P<0.00001),efficacy on angina pectoris(OR=4.25,95%CI 2.79 to 6.45,P<0.00001),traditional Chinese medicine(TCM)syndrome efficacy(OR=4.38,95%CI 2.97 to 6.45,P<0.00001),and ECG efficacy(OR=2.47,95%CI 1.56 to 3.90,P=0.0001),and reduce the number of angina attacks(MD=-0.39,95%CI-0.75 to-0.02,P=0.04),total cholesterol(MD=-0.35,95%CI-0.55 to-0.15,P=0.0006),low-density lipoprotein cholesterin(MD=-0.37,95%CI-0.53 to-0.21,P<0.00001),high-sensitivity C-reactive protein(MD=-1.41,95%CI-2.05 to-0.76,P<0.0001),and left ventricular ejection fraction(LVEF)(OR=1.47,95%CI 0.54 to 2.40,P=0.002).However,the improvement of TCM syndrome score(MD=-2.43,95%CI-5.83 to 0.96,P=0.16)and angina attack duration(MD=-0.44,95%CI-1.18 to 0.30,P=0.24)showed no significant difference compared with the control group.Conclusion:The qi-benefiting and blood-activating therapy can further improve the clinical efficacy of patients with recurrent angina pectoris after PCI for coronary heart disease with good safety.