目的系统评价双联抗血小板联合益气活血类中药防治冠心病经皮冠状动脉介入(PCI)术后再狭窄(ISR)的疗效及安全性。方法计算机检索8个中英文数据库(中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase、Web of Science、the C...目的系统评价双联抗血小板联合益气活血类中药防治冠心病经皮冠状动脉介入(PCI)术后再狭窄(ISR)的疗效及安全性。方法计算机检索8个中英文数据库(中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase、Web of Science、the Cochrane Library),收集从建库至2022年3月10日双联抗血小板联合益气活血类中药治疗冠心病PCI术后病人的随机对照试验(RCT),对照组给予包括双联抗血小板在内的常规西药治疗,试验组在对照组的基础上联用主要功效为益气活血的中药口服剂。采用Cochrane风险偏倚评估工具进行文献质量评价,使用RevMan 5.3软件进行Meta分析。通过敏感性分析、亚组分析找出异质性来源,并用漏斗图分析发表偏倚情况。结果纳入33项RCTs,共2983例病人。Meta分析结果显示,与对照组比较,试验组能降低PCI术后6个月再狭窄发生率[RR=0.40,95%CI(0.31,0.52),P<0.00001],降低全血高切黏度[SMD=-0.55,95%CI(-0.75,-0.34),P<0.00001]、全血低切黏度[SMD=-1.00,95%CI(-1.21,-0.78),P<0.00001]、血浆黏度[SMD=-1.21,95%CI(-2.15,-0.27),P=0.01]、纤维蛋白原[MD=-0.58,95%CI(-0.69,-0.47),P<0.00001]和血细胞比容[MD=-1.42,95%CI(-2.31,-0.54),P=0.002];降低各亚组超敏C反应蛋白(hs-CRP)水平[病程≥6个月组:MD=-2.14,95%CI(-3.23,-1.06),P=0.0001;病程<6个月组:MD=-1.70,95%CI(-2.64,-0.76),P=0.0004];在改善血管舒张功能方面两组差异无统计学意义(P>0.05);在调节一氧化氮[MD=15.81,95%CI(4.70,26.91),P=0.005]和内皮素1[MD=-9.47,95%CI(-11.00,-7.94),P<0.00001]水平方面试验组优于对照组。两组病人发生不良反应均较少,主要表现为消化道出血、牙龈出血、胃肠道反应等,无严重不良反应,对症处理或停药后可消失。结论现有研究表明,双联抗血小板联合益气活血类中药可通过改善PCI术后血液高凝状态,降低炎症反应,保护血管内皮功能,进而降低PCI术后6个月再狭窄发生率,且安全性较好,上述结论仍需多中心、大样本RCT进一步验证。展开更多
Background： Lipid-lowering effect ofRhus coriaria L. （Rhus） has been investigated in multiple animal stud- ies with promising results. Nonetheless, its clinical efficacy has not been adequately examined. Objective...Background： Lipid-lowering effect ofRhus coriaria L. （Rhus） has been investigated in multiple animal stud- ies with promising results. Nonetheless, its clinical efficacy has not been adequately examined. Objective： The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia. Design, setting, participants and interventions： The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyper- lipidemia were randomly assigned to receive Rhus capsules or placebo for 6 weeks. Main outcome measures： The serum lipid levels, apolipoprotein-A1 （Apo-A1） and apolipoprotein-B （Apo-B） were measured. Results： Mean serum high-density lipoprotein cholesterol （HDL-C） and Apo-Al levels were significantly increased in the Rhus group, compared with the placebo group, after 6 weeks of intervention （P= 0.001）. The analysis of covariance test including age, gender, body mass index （BMI）, and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipopro- tein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients （BMI≥ 30 kg/m^2）. Conclusion： The study showed significant increases in HDL-C and Apo-Al levels in response to Rhus sup- plementation in patients with hyperlipidemia. Trial registration： ClinicalTrials.gov ID： NCT02295293.展开更多
基金supported by a grant from Shiraz University of Medical Sciences–Iran (Grant No. 92-5581)
文摘Background： Lipid-lowering effect ofRhus coriaria L. （Rhus） has been investigated in multiple animal stud- ies with promising results. Nonetheless, its clinical efficacy has not been adequately examined. Objective： The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia. Design, setting, participants and interventions： The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyper- lipidemia were randomly assigned to receive Rhus capsules or placebo for 6 weeks. Main outcome measures： The serum lipid levels, apolipoprotein-A1 （Apo-A1） and apolipoprotein-B （Apo-B） were measured. Results： Mean serum high-density lipoprotein cholesterol （HDL-C） and Apo-Al levels were significantly increased in the Rhus group, compared with the placebo group, after 6 weeks of intervention （P= 0.001）. The analysis of covariance test including age, gender, body mass index （BMI）, and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipopro- tein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients （BMI≥ 30 kg/m^2）. Conclusion： The study showed significant increases in HDL-C and Apo-Al levels in response to Rhus sup- plementation in patients with hyperlipidemia. Trial registration： ClinicalTrials.gov ID： NCT02295293.
