血府逐瘀汤联合西医治疗不稳定型心绞痛疗效及改善血管内皮功能的Meta分析

A Meta-Analysis of Xuefu Zhuyu Decoction Combined with Western Medicine in Treating Unstable Angina Pectoris and Improving Vascular Endothelial Function

目的系统评价血府逐瘀汤联合西医治疗不稳定型心绞痛及改善血管内皮功能的疗效。方法计算机检索PubMed、EMBase、Cochrane Library、中国生物医学文献数据库(SinoMed)、维普中文科技期刊数据库(VIP)、中国知网(CNKI)、万方数据库(Wangfang)自建库至2022年8月血府逐瘀汤联合西医组(试验组)与单纯西医组(对照组)治疗不稳定型心绞痛的随机对照试验(RCT),提取RCT资料并按照Cochrane系统评价员手册5.1.0进行质量评价,采用RevMan 5.4及Stata 14统计软件进行数据分析及异质性检验。结果共纳入22项RCT,合计2754例患者。Meta分析结果表明,试验组患者总有效率[OR=3.68,95%CI(2.81,4.82),P<0.00001]、心电图改善率[OR=2.63,95%CI(1.82,3.80),P<0.00001]、血清高密度脂蛋白水平(HDL)[WMD=0.29,95%CI(0.19,0.39),P<0.001]、左室射血分数(LVEF)[WMD=5.35,95%CI(3.73,6.96),P<0.001]及血清一氧化氮(NO)[WMD=25.89,95%CI(20.28,31.50),P<0.001]均显著高于对照组,血清总胆固醇(TC)[WMD=-0.94,95%CI(-1.24,-0.64),P<0.001]、甘油三酯(TG)[WMD=-0.50,95%CI(-0.65,-0.35),P<0.001]、血清低密度脂蛋白(LDL)[WMD=-0.64,95%CI(-1.03,-0.24),P<0.001]、左心室收缩末期内径(LVESD)[WMD=-5.54,95%CI(-7.15,-3.94),P<0.001]、左心室舒张末期内径(LVEDD)[WMD=-5.17,95%CI(-6.41,-3.92),P<0.001]、心绞痛频率[WMD=-1.59,95%CI(-2.42,-0.76),P=0.0002]、心绞痛持续时间[WMD=-2.10,95%CI(-2.84,-1.36),P<0.00001]、C反应蛋白水平(CRP)[WMD=-0.94,95%CI(-1.44,-0.44),P<0.0002]、内皮素(ET)[WMD=-19.62,95%CI(-21.70,-17.54),P<0.001]及白细胞介素6(IL-6)[WMD=-68.10,95%CI(-84.49,-51.71),P<0.001]均显著低于对照组;两组不良反应发生率差异无统计学意义[WMD=0.28,95%CI(0.04,1.81),P=0.18]。结论血府逐瘀汤联合西医治疗不稳定型心绞痛及改善血管内皮功能的疗效较好,可显著改善患者血脂和炎症因子水平。

Objective To systematically assess the effectiveness of Xuefu Zhuyu Decoction in conjunction with western medicine in the treatment of unstable angina pectoris(UAP)and improvement of the vascular endothelium Methods Computer searches of PubMed,EMBase,Cochrane Library,Chinese biology medicine disc(SinoMed),database of Chinese sci-tech periodicals(VIP),China national knowledge infrastructure(CNKI),and Wanfang database were conducted to collect randomized controlled trial(RCT)of Xuefu Zhuyu Decoction combined with western medicine(trial group)and simple western medicine(control group)in the treatment of unstable angina pectoris.The search period was from the establishment of the database to August 2022.Afer extracting the data of RCTs and evaluating the quality according to Cochrane Reviewes'Handbook 5.1.0,we performed data analysis and heterogeneity test using RevMan 5.4 and Stata 14,respectively.Results A total of 22 RCTs were included,with a total of 2754 patients.Results of the meta-analysis revealed that the total effective rate[0R=3.68,95%CI(2.81,4.82),P<0.00001],ECG improvement rate[0R=2.63,95%CI(1.82,3.80),P<0.00001],serum highdensity lipoprotein level(HDL)[WMD=0.29,95%CI(0.19,0.39),P<0.001],left ventricular ejection fraction(LVEF)[WMD=5.35,95%CI(3.73,6.96),P<0.001],and serum nitric oxide(NO)level[WMD=25.89,95%CI(20.28,31.50),P<0.001]in the trial group were all significantly higher than those in the control group.Additionally,total cholesterol(TC)[WMD=-0.94,95%CI(-1.24,-0.64),P<0.001],triglycerides(TC)[WMD=-0.50,95%CI(-0.65,-0.35),P<0.001],serum low-density lipoprotein(LDL)[WMD=-0.64,95%CI(-1.03,-0.24),P<0.001],left ventricular end-systolic diameter(LVESD)[WMD=-5.54,95%CI(-7.15,-3.94),P<0.001],left ventricular end-diastolic diameter(LVEDD)[WMD=-5.17,95%CI(-6.41,-3.92),P<0.001],angina frequency[WMD=-1.59,95%CI(-2.42,-0.76),P=0.0002],angina duration[WMD=-2.10,95%CI(-2.84,-1.36),P<0.00001],C-reactive protein level(CRP)[WMD=-0.94,95%CI(-1.44,-0.44),P=0.0002],endothelin(ET)[WMD=-19.62,95%CI(-21.70,-17.54),P<0.001],and interleukin 6(IL-6)level[WMD=-68.10,95%CI(-84.49,-51.71),P<0.001]in the trial group were all significantly lower than those in the control group.However,the difference of the incidence of adverse reactions[WMD=0.28,95%CI(0.04,1.81),P=0.18]was not statistically significant.Conclusion Xuefu Zhuyu Decoction combined with western medicine exhibited obvious effect for treating unstable angina pectoris and improved vascular endothelial function.Moreover,it could improve blood lipid and inflammatory factor levels of patients.