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不同中成药治疗冠心病心力衰竭的网状Meta分析

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运用网状Meta分析评价不同中成药治疗冠心病心力衰竭的疗效与安全性.通过计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、EMbase、Cochrane Library,搜集建库至 2023 年7 月5 日中成药治疗冠心病心力衰竭的随机对照试验(RCT).根据Cochrane系统评价手册偏倚风险评估工具对符合纳入标准的文献进行质量评价,通过Stata 16.0 软件进行网状Meta分析.最终纳入 82 篇RCTs,总样本量 9 298 例,涉及11 种中成药.网状Meta分析结果显示,①改善临床有效率方面,累计概率排名曲线下面积(SUCRA)排名前 3 的干预措施为芪参益气滴丸+常规西医、振源胶囊+常规西医、通心络胶囊+常规西医;②改善左心室射血分数(LVEF)方面,SUCRA排名前 3的干预措施为麝香保心丸+常规西医、复方丹参滴丸+常规西医、通心络胶囊+常规西医;③降低左心室舒张末期内径(LVEDD)方面,SUCRA排名前 3 的干预措施为麝香通心滴丸+常规西医、通心络胶囊+常规西医、麝香保心丸+常规西医;④降低N末端B型利钠肽前体(NT-proBNP)方面,SUCRA排名前 3 的干预措施为麝香保心丸+常规西医、芪参益气滴丸+常规西医、复方丹参滴丸+常规西医;⑤降低超敏C反应蛋白(hs-CRP)方面,SUCRA排名前 3 的干预措施为脑心通胶囊+常规西医、麝香保心丸+常规西医、复方丹参滴丸+常规西医;⑥改善6 min步行试验(6MWT)方面,SUCRA排名前3 的干预措施为振源胶囊+常规西医、芪苈强心胶囊+常规西医、芪参益气滴丸+常规西医.结果表明,不同中成药联合常规西医治疗冠心病心力衰竭较常规西医能有效改善临床有效率、LVEF和 6MWT,降低LVEDD、NT-proBNP和hs-CRP,但由于纳入文献质量整体偏低,部分中成药纳入文献较少,缺乏不同中成药之间的直接比较等因素,结果还需进一步验证.
Network Meta-analysis of Chinese patent medicines in treatment of coronary heart disease complicated with heart failure
The efficacy and safety of different Chinese patent medicines in the treatment of coronary heart disease complicated with heart failure were evaluated by network Meta-analysis.The randomized controlled trial(RCT)of Chinese patent medicines for coronary heart disease complicated with heart failure was retrieved from CNKI,Wanfang,VIP,SinoMed,PubMed,Web of Science,EMbase,and Cochrane Library with the time interval from inception to July 5,2023.The quality of the included RCT was evaluated by the Co-chrane′s risk of bias assessment tool,and a network Meta-analysis was performed in Stata 16.0.Finally,a total of 82 RCTs were in-cluded,involving 9 298 patients and 11 Chinese patent medicines.Network Meta-analysis yielded the following results based on the surface under the cumulative ranking curve(SUCRA).①In terms of improving the clinical response rate,the top three interventions were Qishen Yiqi Dripping Pills + conventional western medicine,Zhenyuan Capsules + conventional western medicine,and Tongxin-luo Capsules + conventional western medicine.② In terms of increasing left ventricular ejection fraction(LVEF),the top three inter-ventions were Shexiang Baoxin Pills + conventional western medicine,Compound Danshen Dripping Pills + conventional western medi-cine,and Tongxinluo Capsules + conventional western medicine.③ In terms of reducing left ventricular end-diastolic diameter(LVEDD),the top three interventions were Shexiang Tongxin Dripping Pills + conventional western medicine,Tongxinluo Capsules + conventional western medicine,and Shexiang Baoxin Pills + conventional western medicine.④ In terms of reducing N-terminal pro-brain natriuretic peptide(NT-proBNP),the top three interventions were Shexiang Baoxin Pills + conventional western medicine,Qi-shen Yiqi Dripping Pills + conventional western medicine,and Compound Danshen Dripping Pills + conventional western medicine.⑤ In terms of reducing hyper-sensitive C-reactive protein(hs-CRP),the top three interventions were Naoxintong Capsules + conven-tional western medicine,Shexiang Baoxin Pills + conventional western medicine,and Compound Danshen Dripping Pills + conventional western medicine.⑥ In terms of increasing the distance of the six-minute walking trail(6MWT),the top three interventions were Zhen-yuan Capsules + conventional western medicine,Qili Qiangxin Capsules + conventional western medicine,and Qishen Yiqi Dripping Pills + conventional western medicine.The results showed that Chinese patent medicines combined with conventional western medicine can effectively improve the clinical response rate,LVEF,and 6MWT and reduce LVEDD,NT-proBNP,and hs-CRP.However,due to the overall low quality of the articles included and the few articles of some Chinese patent medicines,direct comparison between diffe-rent Chinese patent medicines remains to be carried out and the results need to be further verified.

Chinese patent medicinecoronary heart diseaseheart failurenetwork Meta-analysis

王澳龙、卫靖靖、孙阳、郭红鑫、张铭杰、卢健峰、张艺琳、彭广操、朱明军

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河南中医药大学, 河南 郑州 450000

河南省中药安全评价与风险防控工程研究中心, 河南 郑州 450000

河南中医药大学 第一附属医院, 河南 郑州 450000

中成药 冠心病 心力衰竭 网状Meta分析

国家重点研发计划中医药现代化专项国家重点研发计划中医药现代化专项国家自然科学基金重点项目国家中医药高层次人才-岐黄学者项目河南省中医药科学研究专项

2019YFC17100012019YFC171000082030120CZ02772022JDZX012

2024

中国中药杂志
中国药学会

中国中药杂志

CSTPCD北大核心
影响因子:1.718
ISSN:1001-5302
年,卷(期):2024.49(2)
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