三七制剂对血小板功能影响的系统评价  

Effect of Panax notoginseng preparations on platelet function

作　　者：李越 杨丰文 张明妍 季昭臣 金鑫瑶 吕玲 张俊华 

机构地区：[1]天津中医药大学循证医学中心,天津300193

出　　处：《中国中药杂志》2017年第21期4226-4233,共8页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金项目(81473544)

摘　　要：该研究采用系统评价的方式,评价三七制剂对血小板相关指标的影响作用。通过计算机检索中文全文期刊数据库(CNKI),万方数据库(Wan Fang),中国生物医学文献数据库(Sino Med),the Cochrane Library,Pub Med,EMbase数据库,搜集三七制剂对血小板相关指标影响的随机对照试验(randomized controlled trial,RCT),检索时限均为建库至2017年5月,由2位研究者独立进行文献筛选、资料提取及纳入研究质量评价。最终纳入36个RCT,结局指标包括血小板聚集率(MPAR)、血小板计数(PLT)、血浆血栓烷B2(TXB2)与不良反应。分析结果显示三七制剂与安慰剂[SMD=1.84,95%CI(1.33,2.35),P<0.000 01]与非抗血小板西药[SMD=0.74,95%CI(0.19,1.28),P=0.008]对比可降低MPAR;与非抗血小板西药联用可降低MPAR[SMD=2.34,95%CI(1.14,3.54),P=0.000 1],TXB2(SMD=1.25,95%CI(0.75,1.76),P<0.000 01];与抗血小板西药联用可更好降低MPAR[SMD=0.93,95%CI(0.58,1.29),P<0.000 01],TXB2[SMD=1.16,95%CI(0.74,1.58),P<0.000 01]。在出血性不良反应方面,三七制剂联用抗血小板西药未增加生出血风险。结果表明,三七制剂可降低MPAR与TXB2,且三七制剂与西药常规联用可增加疗效。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。To systematically evaluate the effect of Panax notogin^eng preparations （PNPs） on platelet function six literature data- bases including PubMed, EMbase, the Cochrane Library, CNKI, WanFang, and SinoMed were searched to collect RCTs of PNPs. RCTs reporting the outcomes of platelet function could be included. Biases were evaluated by Cochrane handbook. Two reviewers screened literature, extracted data and assessed the risk of bias of included studies independently. Inconsistency were solved by discus- sion. Meta-analysis was conducted by RevMan 5.3 software. A total of 36 RCTs were involved with the outcome including MPAR, PLT, TXB2 and safety. The results of systematic review showed that compared with placebo [ SMD = 1.84,95% CI （ 1.33,2.35 ）, P 〈 0. 000 01 ] and non-antiplatelet agents [ SMD = 0. 74,95 % CI （0. 19,1.28 ） ,P = 0. 0081 PNPs can reduce the MPAR level ; PNPs com- bined with non-antiplatelet agents can reduce MPAR [ SMD = 2. 34,95 % CI （ 1.14,3. 54） , P = 0. 000 1 ] and TXB2 （ SMD = 1.25,95 % CI （0. 75,1.76 ）, P 〈 0. 000 01 J ; PNPs combined with anti-platelet agents have better effect on MPAR [ SMD = 0. 93,95 % CI （0. 58, 1.29） ,P 〈 0. 000 01 ] and TXB2 [ SMD = 1.16,95% C I （0. 74, I. 58 ）, P 〈 0. 000 01 ]. In terms of hemorrhagic adverse reactions, PNPs combined with anti-platelet agents haven＇t increase adverse events. Current evidences suggested that PNPs can reduce MPAR level and TXB2. PNPs combined with anti-platelet or non-antiplatelet agents can improve efficacy. However, due to the huge clinical het- erogeneity and poor methodological quality, the evidence is not strng enough. Rigorous designed clinical trials are warranted.

关 键 词：三七 血小板 系统评价 META分析 

分 类 号：R259[医药卫生—中西医结合]