中药注射液联合常规西药治疗冠心病稳定型心绞痛的临床疗效及血液流变学影响的网状Meta分析

Clinical Efficacy of Traditional Chinese Medicine Injection Combined with Conventional Western Medicine in the Treatment of Stable Angina Pectoris in Coronary Heart Disease and a Network Meta-analysis of the Influence of Hemorheology

目的基于网状Meta分析系统评价中药注射液联合常规西药治疗冠心病稳定型心绞痛的临床疗效及血液流变学的效果进行评价分析。方法计算机检索中国知网(CNKI)、万方数据知识服务平台(WanFang Data)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Cochrane Library、Web of Science等有关中药注射液联合常规西药治疗冠心病稳定型心绞痛的临床随机对照试验(RCT),检索时限均为建库至2023年4月。采用Cochrane偏倚风险评估工具对所纳入的研究进行质量评价,应用Stata13.0软件进行Meta网状分析。结果最终纳入57篇RCTs,涉及5种中药注射液。网状Meta分析结果显示:(1)在临床总有效率方面:中药注射液疗效排序依次为常规西药治疗联合参麦注射液>参芎葡萄糖注射液>参附注射液>刺五加注射液>黄芪注射液>常规西药治疗;(2)在心绞痛症状有效率方面:中药注射液疗效排序依次为常规西药治疗联合参芎葡萄糖注射液>刺五加注射液+常规疗法>黄芪注射液>参附注射液>参麦注射液>常规西药治疗;(3)在心电图有效率方面:中药注射液疗效排序依次为常规西药治疗联合参麦注射液>参芎葡萄糖注射液>黄芪注射液>刺五加注射液>参附注射液>常规西药治疗;(4)在全血高切粘度改善方面:中药注射液疗效排序依次为常规西药治疗联合参麦注射液>参芎葡萄糖注射液>参附注射液>黄芪注射液>刺五加注射液>常规西药治疗;(5)在全血低切粘度改善方面:中药注射液疗效排序依次为常规西药治疗联合参附注射液>参麦注射液>参芎葡萄糖注射液>刺五加注射液>黄芪注射液>常规西药治疗;(6)在血浆粘度改善方面:中药注射液疗效排序依次为常规西药治疗联合黄芪注射液>参附注射液>参麦注射液>参芎葡萄糖注射液>刺五加注射液>常规西药治疗;(7)在纤维蛋白原改善方面:中药注射液疗效排序依次为常规西药治疗联合参附注射液>参芎葡萄糖注射液>参麦注射液>刺五加注射液注射液>常规西药治疗。结论中药注射液联合常规西药治疗对冠心病稳定型心绞痛效果显著。其中在临床总有效率、心电图和全血高切粘度改善方面,参麦注射液治疗效果最佳;在改善心绞痛症状方面,参芎葡萄糖注射液效果最佳;在全血低切粘度及纤维蛋白原改善方面,参附注射液效果最佳;在血浆粘度改善方面,参附注射液效果最佳,但目前受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objective To evaluate the clinical efficacy and hemorheological effects of traditional Chinese medicine injection combined with conventional Western medicine in the treatment of stable angina pectoris in coronarrt heartdisease using a mesh meta-analysis system.Methods Computer searches were conducted on China National Knowledge Infrastructure(CNKI),WanFang Data Knowledge Service Platform(WanFang Data),VIP,SinoMed,PubMed,Cochrane Library,Web of Science,and other clinical randomized controlled trials(RCTs)related to the combination of traditional Chinese medicine injection and conventional Western medicine for the treatment of stable angina pectoris in coronary heart disease.The search was conducted until April 2023.The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies,and Stata13.0 software was used for meta-analysis.Results 57 RCTs were ultimately included,involving 5 types of traditional Chinese medicine injections.The results of the network metaanalysis showed that:(1)in terms of clinical total effective rate,the efficacy of traditional Chinese medicine injection was ranked in the following order:conventional Western medicine treatment combined with Shenmai injection>Shenxiong glucose injection>Shenfu injection>Ciwujia injection>Huangqi injection>conventional Western medicine treatment;(2)In terms of the effective rate of angina symptoms,the order of efficacy of traditional Chinese medicine injection is conventional Western medicine treatment combined with Shenxiong glucose injection>Ciwujia injection+conventional therapy>Huangqi injection>Shenfu injection>Shenmai injection>conventional Western medicine treatment;(3)In terms of the effective rate of electrocardiogram,the order of efficacy of traditional Chinese medicine injection is conventional Western medicine treatment combined with Shenmai injection>Shenxiong glucose injection>Huangqi injection>Ciwujia injection>Shenfu injection>conventional Western medicine treatment;(4)In terms of improving the high shear viscosity of whole blood,the efficacy of traditional Chinese medicine injection is ranked in the following order:conventional Western medicine treatment combined with Shenmai injection>Shenxiong glucose injection>Shenfu injection>Huangqi injection>Ciwujia injection>conventional Western medicine treatment;(5)In terms of improving whole blood low shear viscosity,the efficacy of traditional Chinese medicine injections is ranked in the following order:conventional Western medicine treatment combined with Shenfu injection>Shenmai injection>Shenxiong glucose injection>Ciwujia injection>Huangqi injection>conventional Western medicine treatment;(6)In terms of improving plasma viscosity,the order of efficacy of traditional Chinese medicine injection is conventional Western medicine treatment combined with Huangqi injection>Shenfu injection>Shenmai injection>Shenxiong glucose injection>Ciwujia injection>conventional Western medicine treatment;(7)In terms of improving fibrinogen,the efficacy ranking of traditional Chinese medicine injection is conventional Western medicine treatment combined with Shenfu injection>Shenxiong glucose injection>Shenmai injection>Ciwujia injection>conventional Western medicine treatment.Conclusion The combination of traditional Chinese medicine injection and conventional Western medicine treatment has a significant effect on stable angina pectoris in coronary heart disease.Among them,Shenmai Injection has the best therapeutic effect in terms of clinical total effective rate,electrocardiogram,and improvement of whole blood high shear viscosity;In terms of improving angina symptoms,Shenxiong Glucose Injection has the best effect;In terms of improving whole blood low shear viscosity and fibrinogen,Shenfu Injection has the best effect;In terms of improving plasma viscosity,Shenfu Injection has the best effect,but currently it is limited by the number and quality of studies included,and the above conclusions still need to be verified by more high-quality studies.