导痰祛瘀药治疗冠心病合并糖尿病临床疗效的Meta分析

A meta-analysis of clinical efficacy of guide phlegm and remove blood stasis in treatment of coronary heart disease complicated with diabetes

目的本研究旨在评估导痰祛瘀药联合西药治疗冠心病合并糖尿病的临床疗效。方法通过计算机检索中国知网(CNKI)、维普(VIP)、万方(WANFANG DATA)、PubMed等数据库,筛选了2015年1月至2022年12月的导痰祛瘀药治疗冠心病合并糖尿病的临床随机对照试验(RCT)。对纳入文献进行质量评估,收集数据,并使用Review Manager 5.4软件进行Meta分析。结果总计检索到182篇相关文献,最终纳入20篇,共包含1755例患者。Meta分析结果显示,采用导痰祛瘀药联合西药治疗的患者在心功能疗效方面明显优于单纯西医治疗的对照组(相对危险比RR=5.71,95%置信区间CI:4.08~7.98,P<0.00001),差异具有统计学意义。治疗组在降低空腹血糖(标准化均值差异SMD=-1V62,95%CI:-1.76~-1.48,P<0.00001)、餐后2 h血糖(SMD=-1.09,95%CI:-1.25~-0.93,P<0.00001)方面也显著优于对照组,差异具有统计学意义。此外,在改善血脂指标方面,治疗组明显优于对照组,包括总胆固醇(MD=-1.69,95%CI:-2.56~-0.82,P=0.0001)、甘油三酯(MD=-0.85,95%CI:-1.05~-0.65,P<0.00001)、高密度脂蛋白胆固醇(MD=0.45,95%CI:0.42~0.48,P<0.00001)、低密度脂蛋白胆固醇(MD=-1.04,95%CI:-1.09~-0.99,P<0.00001)。治疗组在改善血液流变学指标方面也优于对照组,包括血浆黏度(SMD=-0.44,95%CI:-0.72~-0.16,P=0.002)、高切黏度(SMD=-1.19,95%CI:-1.64~-0.74,P<0.00001)、低切黏度(SMD=-2.37,95%CI:-3.53~-1.20,P<0.0001)。结论导痰祛瘀药联合西药治疗对于改善冠心病合并糖尿病患者的临床症状、心功能,以及调节血糖、血脂、降低血液黏度等方面具有显著疗效。

Objective This study aims to evaluate the clinical efficacy of guide phlegm and remove blood stasis combined with Western medicine in the treatment of coronary heart disease(CHD)complicated with diabetes.Methods A computerized search of databases including China National Knowledge Infrastructure(CNKI),VIP,WANFANG DATA,PubMed,and others were conducted to select clinical randomized controlled trials(RCTs)on the use of guide phlegm and remove blood stasis treating CHD complicated with diabetes from January 2015 to December 2022.The selected literature was subjected to quality assessment,data collection,and meta-analysis using Review Manager 5.4 software.Results A total of 182 relevant articles were retrieved,and ultimately,20 studies involving 1755 patients were included.The meta-analysis results revealed that patients treated with guide phlegm and remove blood stasis combined with Western medicine demonstrated a significantly better cardiac functional efficacy compared to the control group receiving Western medicine alone(Relative Risk,RR=5.71,95% Confidence Interval,CI:4.08-7.98,P<0.00001),with statistically significant differences.The treatment group also showed significant superiority in lowering fasting blood glucose(Standardized Mean Difference,SMD=-1.62,95%CI:-1.76 to-1.48,P<0.00001)and postprandial 2-hour blood glucose(SMD=-1.09,95%CI:-1.25 to-0.93,P<0.00001)compared to the control group.Additionally,in improving lipid profiles,the treatment group exhibited significant advantages over the control group,including total cholesterol(Mean Difference,MD=-1.69,95%CI:-2.56 to-0.82,P=0.0001),triglycerides(MD=-0.85,95%CI:-1.05 to-0.65,P<0.00001),high-density lipoprotein cholesterol(MD=0.45,95%CI:0.42 to 0.48,P<0.00001),and low-density lipoprotein cholesterol(MD=-1.04,95%CI:-1.09 to-0.99,P<0.00001).Moreover,the treatment group outperformed the control group in improving hemorheological parameters,including plasma viscosity(SMD=-0.44,95%CI:-0.72 to-0.16,P=0.002),high shear viscosity(SMD=-1.19,95%CI:-1.64 to-0.74,P<0.00001),and low shear viscosity(SMD=-2.37,95%CI:-3.53 to-1.20,P<0.0001).Conclusion The combined use of guide phlegm and remove blood stasis with Western medicine demonstrates significant efficacy in improving clinical symptoms,cardiac function,and regulating blood glucose,lipid levels,and reducing blood viscosity in patients with CHD and concomitant diabetes.