芪参益气滴丸改善急性心肌梗死后左室重构、心功能疗效及安全性的Meta分析

Efficacy and Safety of Qishen Yiqi DrIpping Pill in Improving Left Ventricular Remodeling and Cardiac Function after Acute Myocardial Infarction:a Meta-analysis

目的系统评价常规西药加用芪参益气滴丸改善急性心肌梗死(AMI)后左室重构、心功能疗效及安全性。方法计算机检索中国知网(CNKI)、维普数据库(VIP)、万方数据库(WanFang)、中国生物医学文献数据库(CBMdisc)、PubMed和EMbase,收集符合条件的随机临床对照试验研究(RCT),并进行质量评价及有效资料提取,运用RevMan 5.3.5软件进行Meta分析。结果共纳入合格RCT10个,受试者1 052例,其中试验组529例,对照组523例。Meta分析结果显示:与单纯常规西药治疗比较,加用芪参益气滴丸可进一步提高AMI病人左室射血分数(LVEF)[加权均方差(WMD)=5.77,95%CI(3.68,7.86),P <0.01];减小左室舒张末期内径(LVEDD)[WMD=-3.46,95%CI(-4.90,-2.02),P <0.01]、左室收缩末期内径(LVESD)[WMD=-3.37,95%CI(-6.10,-0.65),P=0.02];可有效降低血清脑钠肽(BNP)[WMD=-44.96,95%CI(-70.04,-19.87),P <0.01]、N末端脑钠肽前体(NT-proBNP)[WMD=-61.65,95%CI(-91.77,-31.54),P <0.01];6 min步行距离差异无统计学意义[WMD=27.51,95%CI(-15.47,70.50),P=0.21];各研究期间未提示服药引起的不良反应及安全性指标异常。结论与常规西药治疗AMI比较,加用芪参益气滴丸可进一步提高疗效。

Objective To systematically evaluate the efficacy and safety of Qishen Yiqi dripping pill(QYDP)and conventional western medicine improving left ventricular remodeling and cardiac function after acute myocardial infarction(AMI).Methods By searching China National Knowledge Infrastructure(CNKI),VIP database,WanFang database,CBMdisc,PubMed and EMbase website,the eligible randomized clinical trials(RCT)were retrieved.The quality of literatures were evaluated,and effective information were obtained.Meta-analysis was performed by RevMan5.3.5 software.Conclusion Ten eligible RCTs studies,1 052 subjects,and529 test groups as well as 523 control groups were enrolled.The result of meta-analysis showed that compared with conventional western medicine treatment,QYDP plus conventional western medicine could improve left ventricular ejection fraction(LVEF)[WMD=5.77,95%CI(3.68,7.86),P<0.01],reduce left ventricular end-diastolic diameter(LVEDD)[WMD=-3.46,95%CI(-4.90,-2.02),P<0.01],reduce left ventricular endsystolic diameter(LVESD)[WMD=-3.37,95%CI(-6.10,-0.65),P=0.02],and effectively reduce brain natriuretic peptide(BNP)[WMD=-44.96,95%CI(-70.04,-19.87),P<0.01],N-terminal pro-brain natriuretic peptide(NT-proBNP)[WMD=-61.65,95%CI(-91.77,-31.54),P<0.01].There was no statistical significance in the effect of improving the six minutes walk distance for patients[WMD=27.51,95%CI(-15.47,70.50),P=0.21].There was no adverse reactions or abnormal safety indicators caused by medication suggested during the study period.Conclusion QYDP can further improve curative effect and the safety in patients with acute myocardial infarction compared with conventional western medicine.However,due to the limited quantity and quality of the included studies,the results suggest that rigorous further and high-quality and larger-scale clinical trials are needed.