口服中成药对原发性高血压患者动脉僵硬度影响的Meta分析

Effect of oral Chinese patent medicine on arterial stiffness in patients with essential hypertension:A Meta-analysis

目的系统评价口服中成药对原发性高血压患者动脉僵硬度的影响。方法计算机检索PubMed、Web of Science、Cochrane Library、中国知网(CNKI)、万方(Wanfang)和维普(VIP)数据库中关于口服中成药影响原发性高血压患者动脉僵硬度的随机对照临床试验,检索时限均从建库至2022年8月31日。对符合标准的文献提取相关资料并进行质量评价。采用Review Manager 5.4和Stata 15.0软件进行Meta分析。结果共纳入18篇文献,包含11种口服中成药,包括1861例患者。在降低脉搏波传导速度水平方面,传统Meta分析显示常规化学药(conventional western medicine,CWM)联合心脉通胶囊、松龄血脉康胶囊、血脂康胶囊、复方丹参滴丸、复方丹参片、复方罗布麻颗粒、虎杖叶胶囊、杞菊地黄丸、冠心舒通胶囊、麝香保心丸、银丹心脑通软胶囊疗效均优于单纯CWM;网状Meta分析显示排名前3的干预措施分别为CWM联合杞菊地黄丸/复方丹参片/麝香保心丸。在降低脉压水平方面,传统Meta分析显示CWM分别联合心脉通胶囊、血脂康胶囊、杞菊地黄丸疗效均优于单纯CWM。在降低收缩压水平方面,传统Meta分析显示CWM分别联合心脉通胶囊、松龄血脉康胶囊、血脂康胶囊、复方丹参滴丸、复方丹参片、复方罗布麻颗粒、杞菊地黄丸、冠心舒通胶囊、银丹心脑通软胶囊疗效均优于单纯CWM;网状Meta分析显示排名前3的干预措施分别为CWM联合杞菊地黄丸/复方丹参滴丸/松龄血脉康胶囊。在降低舒张压水平方面,传统Meta分析显示CWM联合心脉通胶囊、松龄血脉康胶囊、复方丹参滴丸、复方丹参片、复方罗布麻颗粒、冠心舒通胶囊疗效均优于单纯CWM;网状Meta分析显示排名前3的干预措施分别为CWM联合复方丹参片/复方丹参滴丸/复方罗布麻颗粒。在不良反应方面,口服中成药联合CWM治疗总体不良反应较少,安全性较好。结论在CWM治疗基础上联合使用口服中成药能够改善原发性高血压患者动脉僵硬度,但由于各中成药纳入的研究数量及质量间存在差异,且缺乏中成药直接比较的研究,故该结论还有待更加高质量、大样本、多中心的随机双盲对照试验加以证实。

Objective To systematically evaluate the efficacy and safety of oral Chinese patent medicine on arterial stiffness in patients with essential hypertension(EH).Methods Randomized controlled trials concerning the effect of oral Chinese patent medicine on arterial stiffness in patients with EH from PubMed,Web of Science,The Cochrane Library,CNKI,Wanfang,and VIP database from their inception to August 31st 2022 were included by computer retrieval.Literatures were screened according to inclusion and exclusion criteria.Review Manager 5.4 and Stata 15.0 were used to make a meta-analysis after information extracting and quality evaluating.Results A total of 18 studies were included,involving eleven kinds of oral Chinese patent medicine and 1861 patients.The results of the traditional Meta-analysis showed that compared with the group only containing conventional western medicine(CWM),the combination of CWM and Xinmaitong Capsules(心脉通胶囊,XMT),Songling Xuemaikang Capsules(松龄血脉康胶囊,SLXMK),Xuezhikang Capsules(血脂康胶囊,XZK),Compound Danshen Dripping Pills(复方丹参滴丸,FFDSDW),Compound Danshen Tablets(复方丹参片,FFDSP),Compound Apocynum Granules(复方罗布麻颗粒,FFLBM),Huzhangye Capsules(虎杖叶胶囊,HZY),Qiju Dihuang Pills(杞菊地黄丸,QJDH),Guanxin Shutong Capsules(冠心舒通胶囊,GXST),Shexiang Baoxin Pills(麝香保心丸,SXBX),Yindan Xinnao Tong Soft Capsules(银丹心脑通软胶囊,YDXNT)can effectively decrease pulse wave velocity.The results of the network Meta-analysis showed that the top three optimal medication regimens were CWM combined with QJDH,FFDSP,and SXBX.The results of the traditional Meta-analysis showed that compared with the group only containing CWM,the combination of CWM and XMT,XZK,QJDH can effectively decrease pulse pressure;Compared with the group only containing CWM,the combination of CWM and XMT,SLXMK,XZK,FFDSDW,FFDSP,FFLBM,QJDH,GXST,YDXNT can effectively decrease systolic blood pressure.The results of the network Meta-analysis showed that the top three optimal medication regimens were CWM combined with QJDH,FFDSDW,and SLXMK.The results of the traditional Meta-analysis showed that compared with the group only containing CWM,the combination of CWM and XMT,SLXMK,FFDSDW,FFDSP,FFLBM,GXST can effectively decrease diastolic blood pressure.The results of the network Meta-analysis showed that the top three optimal medication regimens were CWM combined with FFDSP,FFDSDW,and FFLBM.In terms of adverse reactions,the combination of oral Chinese patent medicine and CWM had fewer adverse reactions and higher safety.Conclusion The combination of oral Chinese patent medicine and conventional western medicine can effectively improve arterial stiffness in patients with essential hypertension.However,limited by the quantity and quality of included studies,and the lack of direct comparison of oral Chinese patent medicine,the conclusion still needs to be verified by high quality,large sample and multicenter randomized double-blind controlled trials.