脑心通胶囊治疗慢性脑供血不足疗效的Meta分析

Meta-analysis of the Efficacy of Naoxintong Capsules in the Treatment of Chronic Cerebral Blood Supply Deficiency

目的对脑心通胶囊治疗慢性脑供血不足的临床疗效进行Meta分析。方法检索截至2022年5月于中国知网、维普网、万方数据库、Pubmed、Embase、Cochrane Library数据库公开发表的有关脑心通胶囊治疗慢性脑供血不足的随机对照临床试验文献22篇,合计患者1866例。根据用药不同分为对照组和研究组。对照组应用常规西药治疗(盐酸氟桂利嗪、阿司匹林、他汀类等)或其他中成药物。研究组单独应用脑心通胶囊或在对照组的基础上联合应用脑心通胶囊,疗程不限。对文献进行质量评价,并提取文献数据。结果Meta分析结果显示:研究组疗效优于对照组[OR=5.59,95%CI(4.07,7.67)],差异有统计学意义(P<0.00001)。研究组全血高切黏度优于对照组[MD=-4.03,95%CI(-4.05,-4.02)],差异有统计学意义(P<0.00001)。研究组全血低切黏度优于对照组[MD=-0.24,95%CI(-0.36,-0.13)],差异有统计学意义(P<0.0001)。研究组血浆黏度优于对照组[MD=-0.37,95%CI(-0.44,-0.30)],差异有统计学意义(P<0.00001)。研究组红细胞压积优于对照组[MD=-10.67,95%CI(-14.63,-6.70)],差异有统计学意义(P<0.0001)。研究组纤维蛋白原优于对照组[MD=-0.44,95%CI(-0.53,-0.36)],差异有统计学意义(P<0.00001)。研究组血小板凝集率优于对照组[MD=-7.97,95%CI(-9.53,-6.41)],差异有统计学意义(P<0.00001)。研究组收缩峰血流速度优于对照组[MD=17.99,95%CI(16.83,19.15)],差异有统计学意义(P<0.00001)。研究组平均血流速度优于对照组[MD=7.91,95%CI(6.72,9.10)],差异有统计学意义(P<0.00001)。研究组相较对照组提高了左大脑中动脉、右大脑中动脉、大脑中动脉血流速度。研究组基底动脉血流速度优于对照组[MD=5.03,95%CI(2.24,7.82)],差异有统计学意义(P=0.0004)。研究组相较于对照组提高了左、右椎动脉的血流速度。研究组对于改善患者的MMSE评分,相较于对照组[MD=1.45,95%CI(-0.50,3.40)],差异无统计学意义(P=0.15)。结论Meta分析提示脑心通胶囊对于改善慢性脑供血不足患者的临床症状、血液黏度及血流动力学指标均有显著作用。

Objective The clinical effect of Naoxintong Capsule on chronic cerebral insufficiency was analyzed.Methods By May 2022,22 randomized controlled clinical trial literatures on Naoxintong Capsule in the treatment of chronic cerebral insufficiency were searched,including 1866 patients,which were published on CNKI,VIP,Wanfang database,Pubmed,Embase and Cochrane Library database.Divided into control group and study group according to different drug use.The control group was treated with conventional western medicine(flunarizine hydrochloride,aspirin,statins,etc.)or other Chinese medicine.The study group received Naoxintong capsule alone or combined Naoxintong Capsule on the basis of the control group.The course of treatment was not limited.The quality of the literature was evaluated and the literature data was extracted.Results Meta analysis showed that the efficacy of the study group was better than that of the control group[OR=5.59,95%CI(4.07,7.67)],and the difference was statistically significant(P<0.00001).The whole blood high tangential viscosity of the study group was better than that of the control group[MD=4.03,95%CI(4.05,4.02)],and the difference was statistically significant(P<0.00001).Whole blood low tangential viscosity of the study group was better than that of the control group[MD=0.24,95%CI(0.36,0.13)],and the difference was statistically significant(P<0.0001).The plasma viscosity of the study group was better than that of the control group[MD=0.37,95%CI(0.44,0.30)],and the difference was statistically significant(P<0.00001).The hematocrit of the study group was better than that of the control group[MD=10.67,95%CI(14.63,6.70)],and the difference was statistically significant(P<0.0001).The fibrinogen of the study group was better than that of the control group[MD=0.44,95%CI(0.53,0.36)],and the difference was statistically significant(P<0.00001).The platelet agglutination rate of the study group was better than that of the control group[MD=7.97,95%CI(9.53,6.41)],and the difference was statistically significant(P<0.00001).Systolic peak blood flow velocity in the study group was better than that in the control group[MD=17.99,95%CI(16.83,19.15)],and the difference was statistically significant(P<0.00001).The mean blood flow velocity of the study group was better than that of the control group[MD=7.91,95%CI(6.72,9.10)],and the difference was statistically significant(P<0.00001).The left middle cerebral artery,right middle cerebral artery and middle cerebral artery blood flow velocity were increased in the study group compared with the control group.The study group of the basilar artery blood flow velocity better than that of the control group[MD=5.03,95%CI(2.24,7.82)],and the difference was statistically significant(P=0.0004).The blood flow velocity of left and right vertebral arteries was increased in the study group compared with the control group.Compared with the control group[MD=1.45,95%CI(0.50,3.40)],there was no significant difference in MMSE scores in the study group(P=0.15).Conclusion The metaanalysis suggested that Naoxintong capsule had a significant effect on improving the clinical symptoms,blood viscosity and hemodynamic indexes of patients with chronic cerebral insufficiency.