11种中成药治疗扩张型心肌病的网状Meta分析

Network Meta-analysis of 11 Chinese patent medicines in treatment of dilated cardiomyopathy

基于贝叶斯网状Meta分析评估不同中成药治疗扩张型心肌病的有效性及安全性。计算机检索PubMed、EMbase、Cochrane Library、中国知网(CNKI)、万方(Wanfang)、维普(VIP)等数据库自建库至2023年5月口服中成药治疗扩张型心肌病的随机对照试验(RCT)。通过Cochrane偏倚风险评价工具评估文献质量,通过RStudio 3.6.3软件调用“gemtc”包进行数据统计分析。最终纳入96篇RCTs,8452例患者,涉及11种中成药,包含8个结局指标。网状Meta分析显示,①改善临床总有效率方面,除益心舒胶囊+常规西药、麝香保心丸+常规西药、心衰合剂+常规西药外,其余中成药联合常规西药均优于常规西药,其中参芪益气滴丸+常规西药效果最佳;②提高左室射血分数(LVEF)方面,除益心舒胶囊+常规西药、参松养心胶囊+常规西药外,其余中成药联合常规西药均优于常规西药,其中麝香保心丸+常规西药效果最佳;③降低左室舒张末期内径(LVEDD)方面,葛酮通络胶囊+常规西药、心衰合剂+常规西药、黄芪合剂+常规西药、通心络胶囊+常规西药、稳心颗粒+常规西药、芪苈强心胶囊+常规西药均优于常规西药,其中稳心颗粒+常规西药效果最佳;④降低左室收缩末期内径(LVESD)方面,各中成药联合常规西药对比常规西药差异均无统计学意义;⑤提高6 min步行试验(6MWT)方面,养心氏片+常规西药、益心舒胶囊+常规西药、参芪益气滴丸+常规西药、稳心颗粒+常规西药、芪苈强心胶囊+常规西药均优于常规西药,其中参芪益气滴丸+常规西药效果最佳;⑥降低脑钠肽(BNP)方面,心衰合剂+常规西药优于常规西药;⑦降低超敏C-反应蛋白(hs-CRP)方面,参芪益气滴丸+常规西药、芪苈强心胶囊+常规西药优于常规西药,其中芪苈强心胶囊+常规西药效果最好;⑧安全性方面,试验组与对照组均报道了不同程度的不良反应。综上,中成药联合常规西药对扩张型心肌病的疗效更佳,能够缓解临床症状,提高心功能指标,可在临床中根据患者情况个体化用药。但受纳入文献质量与数量的限制,今后仍需多中心、大样本、高质量的RCT进一步验证。

Bayesian network Meta-analysis was performed to evaluate the efficacy and safety of different Chinese patent medicines in the treatment of dilated cardiomyopathy.The PubMed,EMbase,Cochrane Library,CNKI,Wanfang,and VIP were searched for the randomized controlled trial(RCT)from the inception to May 2023.The quality of the included RCT was evaluated by the Cochrane risk of bias assessment tool,and the data were analyzed by RStudio 3.6.3 calling the"gemtc"package.A total of 96 RCTs involving 8452 patients,11 Chinese patent medicines,and 8 outcome indicators were included.Network Meta-analysis is described as follows.①In terms of improving clinical total effective rate,except Yixinshu Capsules+conventional western medicine,Shexiang Baoxin Pills+conventional western medicine,and Xinshuai Mixture+conventional western medicine,the other Chinese patent medicines combined with conventional western medicine were superior to conventional western medicine alone,and Shenqi Yiqi Dropping Pills+conventional western medicine had the best effect.②In terms of improving left ventricular ejection fraction(LVEF),except Yixinshu Capsules+conventional western medicine and Shensong Yangxin Capsules+conventional western medicine,other Chinese patent medicines combined with conventional western medicine outperformed conventional western medicine alone,and Shexiang Baoxin Pills+conventional western medicine had the best effect.③In terms of reducing left ventricular end-diastolic dimension(LVEDD),Getong Tongluo Capsules+conventional western medicine,Xinshuai Mixture+conventional western medicine,Huangqi Mixture+conventional western medicine,Tongxinluo Capsules+conventional western medicine,Wenxin Granules+conventional western medicine,and Qili Qiangxin Capsules+conventional western medicine were better than conventional western medicine alone,and Wenxin Granules+conventional western medicine had the best effect.④There was no significant difference in reducing left ventricular end-systolic diameter(LVESD)between Chinese patent medicines combined with conventional western medicine and conventional western medicine alone.⑤In terms of improving 6-minute walking trail(6MWT),Yangxinshi Tablets+conventional western medicine,Yixinshu Capsules+conventional western medicine,Shenqi Yiqi Dropping Pills+conventional western medicine,Wenxin Granules+conventional western medicine,and Qili Qiangxin Capsules+conventional western medicine were superior to conventional western medicine alone,and Shenqi Yiqi Dropping Pills+conventional western medicine had the best effect.⑥In reducing brain natriuretic peptide(BNP),Xinshuai Mixture+conventional western medicine ourperformed conventional western medicine alone.⑦In reducing hypersensitive C-reactive protein(hs-CRP),Shenqi Yiqi Dropping Pills+conventional western medicine,Qili Qiangxin Capsules+conventional western medicine outperformed conventional western medicine alone,and Qili Qiangxin Capsules+conventional western medicine had the best effect.⑧In terms of safety,adverse reactions were reported in both groups.In conclusion,Chinese patent medicine combined with conventional western medicine were more effective in the treatment of dilated cardiomyopathy.The combinations relieve clinical symptoms and improve cardiac function indexes,and thus can be used according to the patients′conditions in clinical practice.However,limited by the quality and sample size of the included studies,the conclusion remains to be verified by multi-center,large-sample,and high-quality RCT in the future.