活血化瘀类中药注射液辅助治疗急性缺血性卒中的网状Meta分析

Network Meta-analysis of Chinese medicine injections for activating blood and resolving stasis in adjuvant treatment of acute ischemic stroke

运用网状Meta分析,对比活血化瘀类中药注射液联合西医常规治疗急性缺血性卒中(AIS)的疗效,以及对血小板聚集率、纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)的影响,旨在为临床用药提供循证医学参考。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、Web of Science、Cochrane Library、EMbase等数据库,搜集丹参川芎嗪注射液、丹红注射液、疏血通注射液、血栓通注射液、舒血宁注射液、红花黄色素注射液、银杏二萜内酯葡胺注射液等联合西医常规治疗AIS的随机对照试验(RCT),检索时间均为建库至2023年3月18日,由2位研究者筛选提取文献并进行质量评价,采用R 4.2.2进行网状Meta分析。最终纳入87项RCTs,样本量8580例。网状Meta分析结果显示,在减少美国国立卫生研究院卒中量表(NIHSS)评分方面,累计概率排名曲线下面积(SUCRA)排序为血栓通注射液+西医常规(88.7%)>丹参川芎嗪注射液+西医常规(73.7%)>疏血通注射液+西医常规(69.7%)>舒血宁注射液+西医常规(51.8%)>丹红注射液+西医常规(43.7%)>红花黄色素注射液+西医常规(36.8%)>银杏二萜内酯葡胺注射液+西医常规(35.3%)>西医常规(1.7%);在提高了临床总有效率方面,SUCRA排序为丹红注射液+西医常规(63.0%)>舒血宁注射液+西医常规(59.0%)>丹参川芎嗪注射液+西医常规(58.9%)>红花黄色素注射液+西医常规(57.1%)>血栓通注射液+西医常规(56.8%)>舒血通注射液+西医常规(54.6%)>银杏二萜内酯葡胺注射液+西医常规(50.5%)>西医常规(0.03%);在提高Barthel指数方面,SUCRA排序为丹红注射液+西医常规(84.7%)>疏血通注射液+西医常规(72.4%)>红花黄色素注射液+西医常规(61.6%)>丹参川芎嗪注射液+西医常规(44.6%)>银杏二萜内酯葡胺注射液+西医常规(43.2%)>舒血宁注射液+西医常规(42.2%)>西医常规(1.4%);在降低血小板聚集率方面,SUCRA排序为丹参川芎嗪注射液+西医常规(82.4%)>疏血通注射液+西医常规(81.6%)>银杏二萜内酯葡胺注射液+西医常规(40.7%)>丹红注射液+西医常规(37.3%)>西医常规(8.0%);在降低FIB方面,SUCRA排序为丹红注射液+西医常规(81.0%)>丹参川芎嗪注射液+西医常规(71.9%)>银杏二萜内酯葡胺注射液+西医常规(70.0%)>疏血通注射液+西医常规(46.7%)>血栓通注射液+西医常规(22.6%)>西医常规(8.7%);在降低hs-CRP方面,SUCRA排序为舒血宁注射液+西医常规(89.9%)>丹参川芎嗪注射液+西医常规(78.8%)>银杏二萜内酯葡胺注射液+西医常规(52.4%)>丹红注射液+西医常规(47.6%)>血栓通注射液+西医常规(43.5%)>疏血通注射液+西医常规(35.6%)>西医常规(2.3%)。结果显示,血栓通注射液+西医常规、丹红注射液+西医常规、丹参川芎嗪注射液+西医常规综合排序靠前。其中血栓通注射液+西医常规降低NIHSS评分的效果最佳;丹红注射液+西医常规提高患者临床总有效率、Barthel指数及降低FIB的效果最佳;丹参川芎嗪注射液+西医常规降低血小板聚集率效果最佳;舒血宁注射液+西医常规降低hs-CRP的效果最佳。但未来需要更多高质量的RCT加以验证,以提供更加可靠的循证医学参考。

Network Meta-analysis was employed to compare the efficacy of Chinese medicine injections for activating blood and resolving stasis combined with conventional western medicine in the treatment of acute ischemic stroke and the effects on platelet aggregation rate,fibrinogen(FIB),and hypersensitive C-reactive protein(hs-CRP),with a view to providing evidence-based medicine reference for clinical medication.CNKI,Wanfang,VIP,SinoMed,PubMed,Web of Science,Cochrane Library,and EMbase were searched for randomized controlled trial(RCT)on the treatment of acute ischemic stroke with Salvia Miltiorrhiza Ligustrazine Injection,Danhong Injection,Shuxuetong Injection,Xueshuantong Injection,Shuxuening Injection,Safflower Yellow Pigment Injection,and Ginkgo Diterpene Lactone Meglumine Injection combined with conventional western medicine.The retrieval time was from database inception to March 18,2023.The articles were extracted by two researchers and their quality was evaluated.R 4.2.2 was used for network Meta-analysis.A total of 87 RCTs involving 8580 patients were included.Network Meta-analysis showed that,in terms of reducing National Institutes of Health stroke scale(NIHSS)scores,the surface under the cumulative ranking curve(SUCRA)showed the order of Xueshuantong Injection+conventional western medicine(88.7%)>Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine(73.7%)>Shuxuetong Injection+conventional western medicine(69.7%)>Shuxuening Injection+conventional western medicine(51.8%)>Danhong Injection+conventional western medicine(43.7%)>Safflower Yellow Pigment Injection+conventional western medicine(36.8%)>Ginkgo Diterpene Lactone Meglumine Injection+conventional western medicine(35.3%)>conventional western medicine(1.7%).In terms of improving clinical total effective rate,SUCRA showed the order of Danhong Injection+conventional western medicine(63.0%)>Shuxuening Injection+conventional western medicine(59.0%)>Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine(58.9%)>Safflower Yellow Pigment Injection+conventional western medicine(57.1%)>Xueshuantong Injection+conventional western medicine(56.8%)>Shuxuetong Injection+conventional western medicine(54.6%)>Ginkgo Diterpene Lactone Meglumine Injection+conventional western medicine(50.5%)>conventional western medicine(0.03%).In terms of improving Barthel index,SUCRA showed the order of Danhong Injection+conventional western medicine(84.7%)>Shuxuetong Injection+conventional western medicine(72.4%)>Safflower Yellow Pigment Injection+conventional western medicine(61.6%)>Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine(44.6%)>Ginkgo Diterpene Lactone Meglumine Injection+conventional western medicine(43.2%)>Shuxuening Injection+conventional western medicine(42.2%)>conventional western medicine(1.4%).In terms of reducing platelet aggregation rate,SUCRA showed the order of Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine(82.4%)>Shuxuetong Injection+conventional western medicine(81.6%)>Ginkgo Diterpene Lactone Meglumine Injection+conventional western medicine(40.7%)>Danhong Injection+conventional western medicine(37.3%)>conventional western medicine(8.0%).In terms of reducing FIB,SUCRA showed the order of Danhong Injection+conventional western medicine(81.0%)>Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine(71.9%)>Ginkgo Diterpene Lactone Meglumine Injection+conventional western medicine(70.0%)>Shuxuetong Injection+conventional western medicine(46.7%)>Xueshuantong Injection+conventional western medicine(22.6%)>conventional western medicine(8.7%).In terms of reducing hs-CRP,SUCRA showed the order of Shuxuening Injection+conventional western medicine(89.9%)>Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine(78.8%)>Ginkgo Diterpene Lactone Meglumine Injection+conventional western medicine(52.4%)>Danhong Injection+conventional western medicine(47.6%)>Xueshuantong Injection+conventional western medicine(43.5%)>Shuxuetong Injection+conventional Western medicine(35.6%)>conventional western medicine(2.3%).The results indicated that Xueshuantong Injection+conventional western medicine,Danhong Injection+conventional western medicine,and Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine ranked the top three.Xueshuantong Injection+conventional western medicine had the best effect on reducing NIHSS scores.Danhong Injection+conventional western medicine showed the best performance of improving clinical total effective rate,improving Barthel index,and reducing FIB in the blood.Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine had the best effect on reducing platelet aggregation rate in the blood.Shuxuening Injection+conventional western medicine had the best effect on reducing hs-CRP.However,more high-quality RCTs are needed for verification in the future to provide more reliable evidence-based medical reference.