口服中药联合灸法治疗慢性心力衰竭患者有效性和安全性的Meta分析

Efficacy and safety of combined therapy of orally-taking traditional Chinese medicine and moxibustion treatment in patients with chronic heart failure:a Meta-analysis

目的系统评价口服中药联合灸法治疗慢性心力衰竭患者的有效性和安全性。方法检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网(CNKI)、万方数据(Wanfang)、维普(VIP)和中国生物医学文献(SinoMed)数据库中关于口服中药联合灸法治疗慢性心力衰竭患者的随机对照临床试验。对符合标准的文献提取相关资料并进行质量评价。采用Review Manager 5.4软件进行Meta分析。共纳入13篇文献,包括1117例患者,其中试验组559例,对照组558例。结果Meta分析显示:与单独使用西医常规治疗相比,在西医常规治疗的基础上联用口服中药和灸法治疗慢性心力衰竭患者能够明显提高临床总有效率[95%CI(1.13~1.24),P<0.01]、增加LVEF[95%CI(5.06~9.15),P<0.01]、提高6 min步行距离[95%CI(17.28~82.05),P<0.01]、降低NTproBNP[95%CI(-3.90~-0.64),P<0.01]、减小LVEDD[95%CI(-6.42~-1.34),P<0.01],差异均具有统计学意义。不良反应方面,与单独使用西医常规治疗相比,在西医常规治疗的基础上联用口服中药和灸法未明显增加不良反应。结论口服中药联合灸法治疗慢性心力衰竭具有一定的临床疗效和安全性,但本研究存在一定的局限性,上述结论还有待更多高质量、大样本、多中心的随机双盲对照试验加以证实。

AIM To systematically evaluate the efficacy and safety of combined therapy of orally-taking traditional Chinese medicine(TCM)and moxibustion treatment in patients with chronic heart failure(CHF).METHODS Randomized controlled trials(RCTs)concerning the effect of combined therapy of TCM and moxibustion treatment in CHF patients were collected from 8 databases,namely,PubMed,Embase,Web of Science,the Cochrane Library,CNKI,Wanfang,VIP,and SinoMed databases.Literatures were screened on the basis of the inclusion and exclusion criteria.Review Manager 5.4 was used to make a meta-analysis after information extracting and quality evaluating.Thirteen studies involving 1117 patients were included,with 558 patients in the control group(treated only with conventional Western medicine treatment)and 559 patients in the experimental group(treated with the combined therapy of orally-taking TCM and moxibustion treatment on the basis of the control group).RESULTS Meta analysis showed that compared with conventional Western medicine treatment alone,the combination of oral Chinese medicine and moxibustion therapy on the basis of conventional Western medicine treatment can significantly improve the overall clinical effective rate[95%CI(1.13~1.24),P<0.01],increase left ventricular ejection fraction[95%CI(5.06~9.15),P<0.01],increase 6-minute walking distance[95%CI(17.28~82.05),P<0.01],reduce N terminal pro B type natriuretic peptide[95%CI(-3.90~-0.64),P<0.01],and reduce left ventricular end-diastolic dimension[95%CI(-6.42~-1.34),P<0.01].The differences were statistically significant.In terms of adverse reactions,compared to using conventional Western medicine treatment alone,the combination of oral Chinese medicine and moxibustion on the basis of conventional Western medicine treatment did not significantly increase adverse reactions.CONCLUSION Our results have shown that the combined therapy of orally-taking TCM and moxibustion treatment is effective and safe in CHF patients to a certain extent.However,limited by the quantity and quality of included studies,more high-quality and large-scale RCTs involving multiple research centers are still needed.