基于网状Meta分析对8个经典名方治疗不稳定型心绞痛的临床疗效评价

Clinical Efficacy of Eight Classical Prescriptions for Unstable Angina Pectoris Based on Network Meta-analysis

目的:运用网状Meta分析方法系统评价8种经典名方联合西医常规治疗不稳定型心绞痛(UAP)的临床疗效,并分别进一步比较不同经典名方治疗实证和虚证(包括虚实夹杂)2大证型的疗效。方法:检索并筛选中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国国家知识基础设施数据库(CNKI)与中国学术期刊数据库(CSPD)等数据库中关于8个经典名方(血府逐瘀汤、补阳还五汤、四妙勇安汤、丹参饮、炙甘草汤、枳实薤白桂枝汤、瓜蒌薤白半夏汤、化痰祛瘀通脉汤)联合西医常规治疗UAP的随机对照试验(RCT),检索时限从各数据库建库至2022年1月14日,采用Stata 16.0软件进行网状Meta分析。结果:共纳入60个RCT,总计5088例UAP患者,涉及9种干预措施。其中,UAP属实证的有41个RCT,UAP患者共3432例,涉及5种干预措施;虚证或虚实夹杂共13个,共1130例患者,涉及4种干预措施。网状Meta分析结果提示,枳实薤白桂枝汤+西医常规治疗总有效率最优,UAP属实证者,四妙勇安汤+西医常规治疗最佳;虚证或虚实夹杂者,补阳还五汤+西医常规治疗最佳;心电图改善方面,四妙勇安汤疗效最佳;枳实薤白桂枝汤+西医常规在降低超敏C反应蛋白(hs-CRP)改善炎症反应方面更优。结论:与西医常规治疗UAP比较,枳实薤白桂枝汤联合西药常规治疗疗效较显著。但仍需要纳入更多高质量的RCT证实。

Objective:To systematically evaluate the clinical efficacy of eight classical prescriptions combined with conventional western medicine in the treatment of unstable angina pectoris(UAP)by network meta-analysis and compare their effects on sthenia syndromes or asthenia syndromes(including asthenia and sthenia syndromes).Methods:Randomized controlled trials(RCTs)on the treatment of UAP with eight classical prescriptions(Xuefuzhuyutang,Buyanghuanwutang,Simiaoyongantang,Danshenyin,Zhigancaotang,Zhishixiebaiguizhitang,Gualouxiebaibanxiatang,and Huatanquyutongmaitang)combined with conventional western medicine were retrieved from Chinese Citation Database(CCD),China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),and China Science Periodical Database(CSPD)from the establishment to January 14,2022.Stata 16.0 software was used for network Meta-analysis.Results:A total of 60 RCTs were included,involving 5090 patients with UAP and nine intervention measures.Among them,there were 41 RCTs of sthenia syndromes and 3466 UAP patients,involving five kinds of interventions.There were 13 cases of asthenia syndromes or asthenia and sthenia syndromes with 1130 patients,involving four kinds of interventions.The results of the network Meta-analysis suggested that the total effective rate of Zhishixiebaiguizhitang+conventional western medicine was the best.For UAP patients with sthenia syndromes,Simiaoyongantang+conventional western medicine had the optimal treatment effects.For patients with asthenia syndromes or asthenia and sthenia syndromes,Buyanghuanwutang+conventional western medicine was the best.In terms of electrocardiogram,Buyanghuanwutang had the best improvement,and Zhishixiebaiguizhitang+conventional western medicine had the best effect in reducing high-sensitivity C-reactive protein(hs-CRP)and improving inflammatory response.Conclusion:Zhishixiebaiguizhitang+conventional western medicine was more effective than conventional western medicine alone in the treatment of UAP.However,this study needs to be further verified by more high-quality RCTs.