痰瘀同治法治疗冠心病心绞痛的临床疗效及炎症因子影响的网状Meta分析  

Effect of the Method of Dispelling Phlegm and Resolving Stasis on Angina Pectoris in Coronary Heart Disease and Related Indicators:Based on Network Meta-Analysis

作　　者：吴琼[1,2] 王志刚 娄序笙[2] 李园园 陈旻丹 李平 WU Qiong;WANG Zhi-gang;LOU Xu-sheng;LI Yuan-yuan;CHEN Min-dan;LI Ping(Beijing University of Chinese Medicine,Beijing 100029;Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029;Shandong College of Traditional Chinese Medicine,Yantai Shandong 264199;Shenzhen Hospital,Beijing University of Chinese Medicine,Shenzhen Guangdong 518172)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第三附属医院,北京100029 [3]山东中医药高等专科学校,山东烟台264199 [4]北京中医药大学深圳医院(龙岗),广东深圳518172

出　　处：《世界中西医结合杂志》2022年第7期1273-1282,1289,共11页World Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金(81960852)。

摘　　要：目的采用网状Meta分析法评价痰瘀同治法治疗冠心病心绞痛的临床疗效及其对炎症因子的影响。方法检索从建库至2021年10月PubMed医学文献检索服务系统、中国知网(CNKI)、维普期刊数据库(VIP)、万方等数据库发表的有关痰瘀互结型冠心病心绞痛的临床疗效随机对照试验(Randomized Controlled Trial,RCT)。2人独立对文献进行筛选、提取数据和质量评价。运用RevMan 5.4软件进行文献偏倚风险评估,通过Stata 15.1软件以临床总有效率、心绞痛疗效改善率、心电图疗效改善率以及超敏-C反应蛋白(hs-CRP)表达为结局指标进行网状Meta分析并绘图。结果最终纳入37项RCTs,总计3610例患者,其中对照组1798例,治疗组1812例,涉及17种祛痰化瘀的中药方剂。结果显示:以西药常规为共同干预措施,临床总有效率改善的排序为丹蒌片>枳实薤白桂枝汤加减>瓜蒌薤白半夏汤加减>白玉参景脉通汤>温胆汤加减>自拟丹曲方>二陈汤加减>稳斑汤>银丹心脑通软胶囊>化瘀祛痰汤;心电图疗效改善的排序为丹蒌片>益气温阳祛痰化瘀颗粒>瓜蒌薤白半夏汤加减>半夏白术天麻汤加减>化痰祛瘀汤>银丹心脑通软胶囊>小陷胸汤加减>柴蒌桃仁汤>化瘀祛痰汤;心绞痛疗效改善的排序为连夏宁心颗粒>瓜蒌薤白半夏汤加减>化痰祛瘀汤>小陷胸汤加减>柴蒌桃仁汤>益气健脾祛痰化瘀颗粒>丹蒌片;超敏-C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)表达的排序为枳实薤白桂枝汤加减>小陷胸汤加减>二陈汤加减>自拟丹曲方>半夏白术天麻汤加减>温胆汤加减>瓜蒌薤白半夏汤加减。结论痰瘀同治法治疗冠心病心绞痛具有明显优势,其中瓜蒌薤白半夏汤与枳实薤白桂枝汤加减在改善临床总有效率、心绞痛与心电图疗效以及降低炎症因子方面有巨大的潜力。但受现有研究的局限性,还需开展大量设计合理的RCT予以证实。Objective To evaluate the clinical effect of the method of dispelling phlegm and removingstasis on angina pectoris in coronary heart disease and the influence on related indictors based on network Meta-analysis.Methods Randomized controlled trials(RCTs)on the treatment of angina pectoris in coronary heart disease with the syndrome of combined phlegm and stasis were retrieved from PubMed,China National Knowledge Infrastructure(CNKI),VIP,and Wanfang Data(from inception to October 2021).Two researchers independently screened the articles,extracted data,and evaluated the quality.The risk of bias was assessed with RevMan 5.4,and Stata 15.1 was employed for network Meta-analysis of the following outcome indicators:total clinical effective rate,alleviation of angina pectoris,improvement of ECG indications,and expression of high-sensitivity C-reactive protein(hs-CRP).Results A total of 37 eligible RCTs were included,involving 3610 patients(1798 in the control group and 1812 in the treatment group)and 17 prescriptions for dispelling phlegm and resolving stasis.On the basis of conventional western medicine treatment,in terms of the total effective rate,the prescriptions followed the order of Danlou Tablets>Modified Zhishi Xiebai Guizhi Decoction>Modified Gualou Xiebai Banxia Decoction>BaiyuShenjingMaitong Decoction>Modified Wendan Decoction>Danqu Formula>Modified ErchenDecoction>Wenban Decoction>YindanXinnaotong Soft Capsules>HuayuQutan Decoction.As for the improvement of ECG indications,the rank was Danlou Tablets>YiqiWenyangQutanHuayu Granules>Modified GualouXiebaBanxia Decoction>Modified BanxiaBaizhuTianma Decoction>HuayuQutan Decoction>YindanXinnaotong Soft Capsules>Modified Xiaoxianxiong Decoction>Chailou Taoren Decoction>Huayu Qutan Decoction.For the alleviation of angina pectoris,the prescriptions were in the order of Lianxia Ningxin Granules>Modified Gualou Xiebai Banxia Decoction>Huatan Quyu Decoction>Xiaoxianxiong Decoction>ChailouTaoren Decoction>YiqiJianpiQuyuHuatanGraules>Danlou Tablets.In terms of reducing hs

关 键 词：冠心病心绞痛 痰瘀同治法 炎症因子 网状Meta分析 随机对照试验 

分 类 号：R541.4[医药卫生—心血管疾病]