不同活血化瘀中成药注射液预防PCI术后无复流的网状Meta分析  

Network Meta-analysis of different Chinese patent medicine injections for promoting blood circulation and resolving stasis to prevent no-reflow after PCI

作　　者：黄英杰 刘家玥 张悦瑶 霍晨星 温俊茂 罗川晋[2] HUANG Ying-jie;LIU Jia-yue;ZHANG Yue-yao;HUO Chen-xing;WEN Jun-mao;LUO Chuan-jin(The First School of Clinical Medicine,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《中草药》2021年第19期5971-5983,共13页Chinese Traditional and Herbal Drugs

基　　金：国家自然科学基金资助项目(81673923);广东省中医药局科研项目(20181088);广州中医药大学第一临床医学院创新强院团队孵化计划(2018XXDT01)。

摘　　要：目的系统评价不同活血化瘀中成药注射液对患者经皮冠状动脉介入治疗(percutaneouscoronaryintervention,PCI)术后无复流现象预防效果,为临床PCI术后的用药方案提供循证参考。方法计算机检索各大中英文文献数据库,搜集在PCI围术期使用活血化瘀类中成药注射液联合常规治疗(试验组)对比单纯使用常规治疗(对照组)以预防PCI术后无复流现象的随机对照试验(randomizedcontrolledtrial,RCT)。筛选文献后,用Cochrane手册5.3推荐的偏倚风险评估工具评价纳入研究的质量。提取每个结局指标的结果数据,使用Stata 15.1软件进行网状Meta分析。结果共纳入33项RCTs,共3518例患者。网状Meta分析结果显示,常规治疗联合丹参川芎嗪注射液[OR=3.03,95%CI (1.40,6.59)]、丹参注射液[OR=3.11,95%CI(1.44,6.71)]、丹参酮注射液[OR=3.96,95%CI (1.59,9.89)]、丹红注射液[OR=3.16,95%CI (1.63,6.11)]分别与常规治疗比较均能显著降低无复流发生率(P<0.05),丹参酮注射液在降低无复流发生率方面成为最佳干预措施的可能性最大。与常规治疗相比,常规治疗联合丹参注射液[OR=1.07,95%CI (0.30,1.83)]、丹参酮注射液[OR=1.52,95%CI (0.98,2.05)]、参附注射液[OR=1.48,95%CI (0.59,2.37)]、疏血通注射液[OR=1.06,95%CI (0.45,1.67)]均能显著降低不良心血管事件(major adverse cardiovascular events,MACE)发生率(P<0.05),丹参酮注射液在降低MACE发生率方面成为最佳干预措施的可能性最大。与常规治疗相比,常规治疗联合丹参酮注射液[OR=-2.11,95%CI (-3.70,-0.51)]、丹红注射液[OR=-1.99,95%CI(-2.81,-1.17)]、疏血通注射液[OR=-0.53,95%CI (-0.96,-0.10)]均能显著升高心电图ST段回落率(P<0.05),丹红注射液在提高心电图ST段回落率方面疗效最好的可能性最大。结论在降低PCI术后无复流发生率、MACE发生率方面,丹参酮注射液效果最好的可能性最大;在提升心电图ST段回落率方面,丹红注射液效果最佳的可能�Objective To systematically evaluate the difference in the effect of preventing no-reflow after percutaneous coronary intervention(PCI) among different traditional Chinese patent medicine injections for promoting blood circulation and resolving stasis, and provide evidence-based reference for PCI clinical drug use. Methods Computer retrieval of PubMed, CBM, Cochrane Library, Wanfang database, EmBase, China Knowledge Network database was carried out. The randomized controlled trial(RCT), extracted data of conventional PCI surgery treatment combined with traditional Chinese patent medicine injections for promoting blood circulation and resolving stasis(treatment group) in the prevention of no-reflow after PCI were compared with conventional PCI surgery treatment alone(control group), and the quality of the document was evaluated by Cochrane system evaluator’s manual 5.3. The results of each outcome index were extracted and Meta-analysis was performed using Stata 15.1 software. Results A total of 33 RCTs containing 3518 patients documents were included. Meta-analysis showed that Danshen Chuanxiongqin Injection(丹参川芎嗪注射液) [OR = 3.03, 95% CI(1.40, 6.59)], Danshen Injection(丹参注射液) [OR = 3.11,95%CI(1.44, 6.71)], Tanshinone Injection(丹参酮注射液) [OR = 3.96,95%CI(1.59, 9.89)] and Danhong Injection(丹红注射液) [OR = 3.16,95% CI(1.63, 6.11)] combined with conventional therapy could significantly reduce the incidence of no-reflow compared with conventional treatment(P < 0.05), and Tanshinone Injection was the most effective in reducing the incidence of no-reflow. The network Meta-analysis showed that Danshen Injection [OR = 1.07, 95% CI(0.30, 1.83)], Tanshinone Injection [OR = 1.52, 95% CI(0.98, 2.05)], Shenfu Injection(参附注射液) [OR = 1.48, 95% CI(0.59, 2.37)], Shuxuetong Injection(疏血通注射液) [OR = 1.06, 95% CI(0.45, 1.67)] combined with conventional therapy could significantly reduce the incidence of MACE compared with conventional treatment(P < 0.05), and Tanshinone

关 键 词：活血化瘀 经皮冠状动脉介入治疗术后 无复流现象 网状Meta分析 丹参酮注射液 丹红注射液 丹参川芎嗪注射液 

分 类 号：R285.64[医药卫生—中药学]