中西医结合治疗对冠状动脉粥样硬化性心脏病合并糖尿病疗效与安全性的Meta分析

A Meta-analysis of efficacy and safety of the integrated medicine on coronary heart disease with diabetes

目的:系统评价中西医结合治疗对冠状动脉粥样硬化性心脏病(简称冠心病)合并糖尿病的疗效,以期提供更合理的临床治疗方案。方法:计算机检索中国期刊全文数据库、万方数据库、中文科技期刊全文数据库等,检索期限均从建库至2022年10月,收集中西医结合治疗冠心病合并糖尿病的随机对照试验,应用Cochrane偏倚风险评估工具评估偏倚风险,采用RevMan 5.3软件对纳入的研究进行方法学质量评价,采用STATA 15.1软件进行统计分析。结果:共有18篇随机对照试验文献被纳入,包括1 478例患者。Meta分析结果显示,与对照组相比,试验组总有效率显著提高[OR=2.78,95%CI(2.26,3.41),P <0.05];试验组血糖显著降低[SMD=-0.45,95%CI(-0.56,-0.34),P <0.001];低密度脂蛋白胆固醇水平显著降低[MD=-0.49,95%CI(-0.60,-0.38),P <0.01];心电图显著改善[OR=2.47,95%CI(1.63,3.74),Z=4.268,P <0.05];两组不良反应发生率无显著差异。结论:中西医结合治疗冠心病合并糖尿病较单纯西医治疗可显著提高临床疗效、降低患者血糖及低密度脂蛋白胆固醇水平,并且具有良好的安全性;黄芪-丹参-葛根配伍在中医治疗冠心病合并糖尿病中是常用的药物配伍方案,为以后的临床应用及基础研究提供了方向。

Objective:To systematically evaluate the efficacy of the integrated medicine in the treatment of coronary heart disease complicated with diabetes,in order to provide a more reasonable clinical treatment plan.Methods:Chinese Journal fulltext Database(CNKI),Wanfang(WANFANG)database and Chinese Sci-tech Journal full-text database(VIP)were searched by computer.From the establishment of the database to October 2022,randomized controlled trials(RCTs)of traditional Chinese medicine plus western medicine in the treatment of coronary heart disease complicated with diabetes mellitus were collected.Cochrane bias risk assessment tool was used to evaluate the bias risk of the included study.RevMan 5.3 software was used to evaluate the methodological quality of the included study.STATA 15.1 software was used for a statistical analysis.Results:A total of 18 RCT articles were included,including 1478 patients.The results of Meta-analysis showed that the effective rate in the experimental group was significantly higher than that in the control group[OR=2.78,95%CI(2.26,3.41),P<0.001],and the blood glucose in the experimental group was significantly lower than that in the control group[SMD=-0.45,95%CI(-0.56,-0.34),P<0.001].The level of low density lipoprotein cholesterol in the experimental group was decreased significantly[MD=-0.49,95%CI(-0.60,-0.38),P<0.01],and the ECG in the experimental group was significantly ameliorated[OR=2.47,95%CI(1.63,3.74),Z=4.268,P<0.05].There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion:Compared with western medicine alone,the integrated medicine on coronary heart disease complicated with diabetes can significantly improve the clinical efficacy,reduce the level of blood glucose and low density lipoprotein cholesterol,and has good safety.Huangqi(Radix Astragali)-Danshen(Radix et Rhizoma Salviae Miltiorrhizae)-Gegen(Radix Puerariae Lobatae)compatibility is a commonly used drug compatibility scheme in the TCM treatment of coronary heart disease complicated with diabetes,which provides a direction for future clinical application and basic research.