中药注射液治疗扩张型心肌病的网状Meta分析  

Treatment of dilated cardiomyopathy with Chinese medicinal injections:a Bayesian network Meta-analysis

作　　者：贾秋蕾 袁果真 胡元会[2] 石晶晶[2] 石树青 魏艺[2] Jia Qiulei;Yuan Guozhen;Hu Yuanhui;Shi Jingjing;Shi Shuqing;Wei Yi(School of Clinical Medicine,Beijing University of Chinese Medicine,Beijing 100029,China;不详)

机构地区：[1]北京中医药大学临床医学院,北京100029 [2]中国中医科学院广安门医院心内科,北京100053

出　　处：《中国循证心血管医学杂志》2021年第12期1418-1424,1442,共8页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金面上项目(81673971)。

摘　　要：目的运用网状Meta分析方法系统评价中药注射液治疗扩张型心肌病(DCM)的效果。方法计算机检索知网、万方、维普、中国生物医学文献数据库、Medline、EMbase、Cochrane Library及Clinicaltrails,检索时间为各数据库建库至2020年5月31日,按照设定的纳排标准筛选出治疗DCM的随机对照试验。由2位研究者独立筛选文献、提取资料。采用Cochrane协作网的ROB工具对纳入研究进行质量评价,R3.6.2软件的gemtc包、OpenBUGS软件和Stata 14.0软件进行数据分析。结果最终纳入25个RCT,涉及7种中药注射液。除参芪扶正注射液外,各中药注射液均能一定程度上改善DCM患者的心功能,网状Meta分析结果显示:在NYHA心功能分级改善有效率方面,丹参川芎嗪注射液联合西药常规治疗可能在改善心功能分级方面最为有效,其次是黄芪注射液、参附注射液、参麦注射液、生脉注射液;在提高左室射血分数(LVEF)值方面,效果最好的可能是生脉注射液联合常规治疗,其次是参附注射液、丹参川芎嗪注射液、参麦注射液;在改善左室舒张末期内径(LVEDD)方面,参麦注射液可能优于参附注射液。结论中药注射液一定程度上能改善DCM患者的心功能,但不同中药注射液在各个结局指标中的疗效排序差异较大,且受所纳入文献的数量及质量的影响,上述结论需在今后研究中得到验证。Objective To review systematically the effects of Chinese medicinal injections on dilated cardiomyopathy(DCM)by applying network Meta-analysis.Methods The databases of CNKI,WanFang Data,VIP,CBM,MedLine,EMbase,Cochrane Library and Clinicaltrails were retrieved with computer from database establishment time to May 31,2020 to screen randomized controlled trial(RCT)of DCM treatment according to inclusion and exclusion criteria.The literature and data were screened and extracted by 2 researchers independently.The quality of included studies was reviewed by using ROB tool of Cochrane network.The data was analyzed by using gemtc package of R3.6.2 software,OpenBUGS software and Stata 14.0 software.Results There were totally 25 RCT included involved 7 Chinese medicinal injections.Except of Shenqi Fuzheng Injection,other injections improved heart function to some extent in DCM patients.The results of network Meta analysis showed that in terms of effective rate of NYHA functional classification improvement,Danshen Chuanxiongqin Injection combined with routine Western medicine was the most effective,followed by Huangqi Injection,Shenfu Injection,Shenmai Injection,Shengmai Injection.In the terms of LVEF improvement,Shengmai Injection combined with routine Western medicine was the most effective,followed by Shenfu Injection,Danshen Chuanxiongqin Injection and Shenmai Injection.In the terms of LVEDD improvement,Shenmai Injection was possibly superior to Shenfu Injection.Conclusion Chinese medicinal injections can improve heart function to some extent in DCM patients,but different injections have different outcome indicators in different efficacy ranking,and are affected by quantity and quality of included literature.The conclusion should be verified in future studies.

关 键 词：扩张型心肌病 中药注射液 贝叶斯网状Meta分析 随机对照试验 

分 类 号：R542.2[医药卫生—心血管疾病]