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中药注射液治疗慢性肺源性心脏病的网状Meta分析

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基于网状Meta分析系统评价不同中药注射液治疗慢性肺源性心脏病(CPHD)的有效性及安全性。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)、Web of Science、PubMed、EMbase、Cochrane Li-brary数据库建库至 2023 年 10 月 1 日发表的中药注射液治疗CPHD的随机对照试验(RCT)。采用Cochrane系统评价手册5。3 版推荐的偏倚风险评估工具对纳入文献进行质量评价,运用Stata 17。0、RevMan 5。4 软件对数据进行统计分析。最终纳入103 篇RCTs,9 332 例患者,涉及13 种中药注射液。网状Meta分析结果显示,①提高临床总有效率方面,累计概率排名曲线下面积(SUCRA)排名前 3 的干预措施依次为疏血通注射液+常规西医>川芎嗪注射液+常规西医>心脉隆注射液+常规西医;②降低肺动脉压方面,SUCRA排名前 3 的干预措施依次为丹参川芎嗪注射液+常规西医>川芎嗪注射液+常规西医>参麦注射液+常规西医;③提高左心室射血分数(LVEF)方面,SUCRA排名前 3 的干预措施依次为心脉隆注射液+常规西医>丹红注射液+常规西医>银杏达莫注射液+常规西医;④降低脑钠肽(BNP)方面,SUCRA排名前 3 的干预措施依次为心脉隆注射液+常规西医>银杏达莫注射液+常规西医>丹红注射液+常规西医;⑤提高动脉血氧分压(PaO2)、降低动脉二氧化碳分压(PaCO2)方面,SUCRA排名前 3 的干预措施依次为参芎葡萄糖注射液+常规西医>参麦注射液+常规西医>参附注射液+常规西医;⑥提高动脉血氧饱和度(SaO2)方面,SUCRA排名前 3 的干预措施依次为丹参川芎嗪注射液+常规西医>心脉隆注射液+常规西医>参麦注射液+常规西医;⑦提高第 1 秒用力呼气容积百分比(FEV1%)方面,SUCRA排名前 3 的干预措施依次为参附注射液+常规西医>丹参酮ⅡA 磺酸钠注射液+常规西医>参麦注射液+常规西医;⑧提高第 1 秒用力呼气容积/用力肺活量(FEV1/FVC)方面,SUCRA排名前 3 的干预措施依次为丹参川芎嗪注射液+常规西医>疏血通注射液+常规西医>丹红注射液+常规西医;⑨安全性方面,试验组与对照组治疗期间均未出现严重的药物不良反应。综上,在常规西医治疗基础上联合中药注射液能够提高CPHD的综合疗效,降低肺动脉压,改善心肺功能及动脉血气水平。但鉴于纳入文献方法学质量与数量的限制,上述结论有待更多设计严谨且高质量的RCT进一步验证。
Network Meta-analysis of traditional Chinese medicine injections in treatment of chronic pulmonary heart disease
Based on the network Meta-analysis,the efficacy and safety of different traditional Chinese medicine(TCM)injections in the treatment of chronic pulmonary heart disease(CPHD)were systematically evaluated.CNKI,Wanfang,VIP,SinoMed,Web of Science,PubMed,EMbase,and Cochrane Library were searched to collect randomized controlled trial(RCT)of TCM injection in the treatment of CPHD from inception to October 1,2023.The quality of the included studies was evaluated by the bias risk assessment tool recommended by the Cochrane systematic evaluation manual version 5.3.Stata 17.0 and RevMan 5.4 software were used for statis-tical analysis of the data.Finally,103 RCTs were included,involving 9 332 patients and 13 kinds of TCM injections.Network Meta-analysis yielded the following results.①In terms of improving the total clinical effective rate,the top three intervention measures in SUCRA ranking are Shuxuetong Injection+conventional western medicine>Ligustrazine Injection+conventional western medicine>Xinmailong Injection+conventional western medicine.②In terms of reducing pulmonary artery pressure,the top three intervention measures in SUCRA ranking are Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine>Ligustrazine Injection+conventional western medicine>Shenmai Injection+conventional western medicine.③In terms of improving left ventricular ejection fraction(LVEF),the top three intervention measures in SUCRA ranking are Xinmailong Injection+conventional western medicine>Danhong Injection+conventional western medicine>Ginkgo Damo Injection+conventional western medicine.④ In terms of reducing brain natriuretic peptide(BNP),the top three intervention measures in SUCRA ranking are Xinmailong Injection+conventional wes-tern medicine>Ginkgo Damo Injection+conventional western medicine>Danhong Injection+conventional western medicine.⑤ In terms of increasing arterial oxygen partial pressure(PaO2)and reducing arterial carbon dioxide partial pressure(PaCO2),the top three intervention measures in SUCRA ranking are Shenxiong Glucose Injection+conventional western medicine>Shenmai Injection+conventional western medicine>Shenfu Injection+conventional western medicine.⑥ In terms of improving arterial oxygen saturation(SaO2),the top three intervention measures in SUCRA ranking are Salvia Miltiorrhiza Ligustrazine Injection+conventional western medicine>Xinmailong Injection+conventional western medicine>Shenmai Injection+conventional western medicine.⑦ In terms of increasing the percentage of forced expiratory volume in the first second(FEV1%),the top three intervention measures in SUCRA ranking are Shenfu Injection+conventional western medicine>Tanshinone Sodium ⅡA Sulfonate Injection+conventional western medi-cine>Shenmai Injection+conventional western medicine.⑧ In terms of increasing the proportion of forced expiratory volume to forced vital capacity in the first second(FEV1/FVC),the top three intervention measures in SUCRA ranking are Salvia Miltiorrhiza Ligus-trazine Injection+conventional western medicine>Shuxuetong Injection+conventional western medicine>Danhong Injection+conven-tional western medicine.⑨ In terms of safety,neither the experimental group nor the control group experienced any serious adverse drug reactions during the treatment period.In summary,combining TCM injection with conventional western medicine treatment can improve the comprehensive efficacy of treating CPHD,reduce pulmonary artery pressure,and improve cardiopulmonary function and ar-terial blood gas levels.However,due to the limitations of the quality and quantity of research methodology included,the above conclu-sions need to be further validated by more well-designed and high-quality RCT.

chronic pulmonary heart diseasetraditional Chinese medicine injectionnetwork Meta-analysis

班纪芳、王贺、王卓溪、周亚滨、客蕊

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黑龙江中医药大学,黑龙江 哈尔滨 150040

黑龙江中医药大学 附属第一医院,黑龙江 哈尔滨 150040

慢性肺源性心脏病 中药注射液 网状Meta分析

黑龙江省中医药科研项目黑龙江省应用技术研究与开发计划黑龙江省中医药经典普及化专项

ZHY2020-124GY2019YF0237ZYW2023-066

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(10)
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