中药注射液防治蒽环类抗生素致心脏损伤的网状Meta分析  

Network Meta-analysis of traditional Chinese medicine injections against anthracycline-induced cardiac injury

作　　者：王海坤 吴娜[1] 苏丹 冯晓俊 WANG Hai-kun;WU Na;SU Dan;FENG Xiao-jun(Bozhou Hospital of Anhui Medical University,Bozhou 236800,China;the First Affliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]安徽医科大学附属亳州医院,安徽亳州236800 [2]中国科学技术大学附属第一医院,安徽合肥230001

出　　处：《中国中药杂志》2022年第16期4517-4528,共12页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金青年基金项目(82003740);亳州市人民医院三新项目(2021YB-87)。

摘　　要：系统评价中药注射液防治蒽环类抗生素致心脏损伤的效果。计算机检索Cochrane Library、PubMed、EMbase、中国知网(CNKI)等数据库,搜索中药注射液防治蒽环类抗生素致心脏损伤的随机对照试验(RCTs),检索时限从建库至2021年9月。由2位研究者独立筛选文献并提取数据,评估纳入研究的偏倚风险,应用R 4.1.0和Stata 15.1软件进行网状Meta分析。最终纳入50篇文献,涉及8种中药注射液。网状Meta分析结果显示,①蒽环类抗生素联用华蟾素注射液可能是降低心电图异常的最佳方案;②联用参附注射液可能是改善左室射血分数(LVEF)降低的最佳方案;③联用参芪扶正注射液可能是降低心脏毒性发生率的最佳方案;④联用心脉隆注射液可能是改善肌钙蛋白I(cTnI)升高的最佳方案;⑤联用参麦注射液可能是改善肌酸激酶同工酶(CK-MB)升高的最佳方案;⑥联用苦参注射液可能是胃肠反应最低的方案。结果表明,中药注射液对蒽环类抗生素致心脏损伤的防治效果较好,不良反应发生率低,且每种中药注射液都有其独特的优势。受纳入研究的质量和方法学的局限性,该结论尚需更多高水平RCTs进行验证。This study aimed to systematically evaluate the effect of traditional Chinese medicine(TCM) injections on anthracycline-induced cardiac injury. The Cochrane Library, PubMed, EMbase, CNKI, and other databases were electronically retrieved to gather randomized controlled trials(RCTs) of TCM injections against anthracycline-induced cardiac injury from their inception to September 2021. After two research fellows independently screened the literature and extracted the data, the risk of bias of included RCTs was assessed and network Meta-analysis was performed by R 4.1.0 and Stata 15.1. A total of 50 RCTs were included, involving eight TCM injections. Network Meta-analysis showed that:①the combination of anthracyclines with Huachansu Injection might be the optimal treatment to reduce the abnormal electrocardiogram.②The combination with Shenfu Injection might be the optimum treatment to ameliorate the left ventricular ejection fraction(LVEF) decrease.③The combination with Shenqi Fuzheng Injection might reduce the incidence of cardiotoxicity most satisfactorily.④The combination with Xinmailong Injection might improve the elevated cardiac troponin I(cTnI) optimally.⑤The combination with Shenmai Injection might be optimal to control the rise of creatine kinase MB isoenzyme(CK-MB).⑥The combination with Kushen Injection might be the regimen with the lowest gastrointestinal reactions. TCM injections had desirable effect on anthracycline-induced cardiac injury, with low incidence of adverse reactions, and each TCM injection had its own unique advantages. Due to the limitations in quality and methodological conduct of the included studies, more high-level RCTs are needed to validate the conclusions.

关 键 词：中药注射液 蒽环类抗生素 心脏损伤 网状Meta分析 

分 类 号：R285.6[医药卫生—中药学]