口服中成药联合常规西药治疗稳定型心绞痛的网状Meta分析

Network Meta-analysis of treating stable angina pectoris with oral Chinese patent medicines plus conventional western medicine

目的:运用网状Meta分析方法系统评价中成药联合常规西药治疗稳定型心绞痛的有效性及安全性。方法:计算机检索PubMed、The Cochrane Library、Embase、Web of Science、万方、维普、知网和中国生物医学文献数据库,搜集中成药联合常规西药治疗稳定型心绞痛的随机对照试验,检索时限均为建库至2022年2月10日。采用RevMan5.3、STATA15.1软件进行数据统计分析。结果:共纳入70项随机对照试验,包括6 973例患者,涉及7种中成药。网状Meta分析结果显示:(1)在提高心绞痛疗效方面,排序依次为养心氏片+常规西药>麝香保心丸+常规西药>冠心舒通胶囊+常规西药>芪参益气滴丸+常规西药>丹蒌片+常规西药>心可舒片+常规西药>益心舒胶囊+常规西药>常规西药;(2)在提高心电图疗效方面,排序依次为芪参益气滴丸+常规西药>养心氏片+常规西药>麝香保心丸+常规西药>冠心舒通胶囊+常规西药>心可舒片+常规西药>益心舒胶囊+常规西药>丹蒌片+常规西药>常规西药;(3)在升高高密度脂蛋白胆固醇方面,排序依次为冠心舒通胶囊+常规西药>益心舒胶囊+常规西药>麝香保心丸+常规西药>心可舒片+常规西药>常规西药;(4)在降低低密度脂蛋白胆固醇方面,排序依次为养心氏片+常规西药>益心舒胶囊+常规西药>冠心舒通胶囊+常规西药>丹蒌片+常规西药>心可舒片+常规西药>麝香保心丸+常规西药>常规西药;(5)在安全性方面,中成药联合常规西药的不良反应整体少于对照组。结论:本研究表明,中成药联合常规西药治疗稳定型心绞痛可显著提高其心绞痛及心电图疗效,同时具有调脂作用且安全性更好。但部分纳入研究的方法学质量不佳,故此结论需进一步在更多高质量研究中予以验证。

Objective:The safety and efficacy of Chinese patent medicines plus conventional western medicine on stable angina pectoris was systematically evaluated by mesh Meta-analysis.Results:PubMed,The Cochrane Library,Embase,Web of Science,WanFang Data,VIP,CNKI and CBM databases were searched to collect randomized controlled trials(RCTs)of Chinese patent medicines combined with conventional western medicine in the treatment of stable angina.The retrieval time is from the database construction to February 10,2022.RevMan5.3 and STATA15.1 software were used for data statistical analysis.Results:Seventy RCTs were included,including 6973 patients.A total of 7 kinds of Chinese patent medicines are involved.The results of mesh Meta-analysis showed that:①The therapeutic effect of angina pectoris was ranked as follows:the Yangxinshi tablets(养心氏片)+conventional western medicine>the Shexiang Baoxin Wan(麝香保心丸)+conventional western medicine>the Guanxin Shutong capsules(冠心舒通胶囊)+conventional western medicine>the Qishen Yiqi dripping pills(芪参益气滴丸)+conventional western medicine>the Danlou tablets(丹蒌片)+conventional western medicine>the Xinkeshu tablets(心可舒片)+conventional western medicine>the Yixinshu capsules(益心舒胶囊)+conventional western medicine>conventional western medicine.②In terms of improving the efficacy of ECG,the order is the Qishen Yiqi dripping pills+conventional Western medicine>the Yangxin Shi tablets+conventional western medicine>the Shexiang Baoxin Wan+conventional western medicine>the Guanxin Shutong capsules+conventional western medicine>the Xinke Shu tablets+conventional western medicine>the Yixin Shu capsules+conventional Western medicine>the Danlou tablets+conventional western medicine>conventional western medicine.③In terms of increasing HDL cholesterol,the order is the Guanxin Shutong capsules+conventional western medicine>the Yixin Shu capsules+conventional western medicine>the Shexiang Baoxin Wan+conventional western medicine>the Xinke Shu tablets+conventional western medicine>conventional western medicine.④In terms of reducing LDL cholesterol,the order is the Yangxin Shi tablets+conventional western medicine>the Yixin Shu capsules+conventional western medicine>the Guanxin Shutong capsules+conventional western medicine>the Danlou tablets+conventional western medicine>the Xinke Shu tablets+conventional western medicine>the Shexiang Baoxin Wan+conventional western medicine conventional western medicine.⑤In terms of safety,the adverse reactions of Chinese patent medicines plus conventional western medicine were generally less than those in the control group.Conclusion:This study showed that Chinese patent medicines plus conventional western medicine in the treatment of stable angina pectoris can significantly improve its clinical efficacy,angina pectoris efficacy and ECG efficacy,and has lipid regulation,anti-inflammatory effects,and better safety.However,the methodological quality of some included studies was low,so this conclusion needs to be further verified in more high-quality studies.