5种中成药联合西医常规疗法治疗冠心病合并焦虑抑郁的网状meta分析  

A network meta-analysis of 5 Chinese patent medicines combined with conventional westernmedicine in the treatment of coronary heart disease complicated with anxiety anddepression

作　　者：曾丽萍 曾建斌[1] 万蝉俊[1] 丁聪 Zeng Liping;Zeng Jianbin;Wan Chanjun;Ding Cong(The Affiliated Hospital of Jiangxi University of Chinese Medicine,Branch of National Clinical Research Center for Chinese Medicine Cardiolog,Nanchang 330000,China)

机构地区：[1]江西中医药大学附属医院国家中医心血管病临床医学研究中心分中心,南昌330000

出　　处：《国际中医中药杂志》2023年第4期472-480,共9页International Journal of Traditional Chinese Medicine

基　　金：国家中医药循证能力建设项目(2019XZZX-XXG005)。

摘　　要：目的评价5种不同中成药联合西医常规疗法治疗冠心病合并焦虑抑郁的临床疗效。方法检索中国学术期刊数据库(万方数据)、中国生物医学文献服务系统(SinoMed)、中国知识资源总库(CNKI)、中文科技期刊数据库(重庆维普)、Cochrane Library、PubMed和Embase数据库2010年1月1日-2020年12月31日有关中成药联合西医常规疗法治疗冠心病合并焦虑抑郁的RCT研究文献,采用Jadad评分和Cochrane偏倚风险评估工具对纳入文献进行偏倚风险评估。采用RevMan 5.3、Stata 16.0及GeMTC 14.3软件进行网状meta分析。结果共纳入文献32篇,涉及患者3494例。临床有效率方面,西医常规疗法联合振源胶囊[OR(95%CI)为16.64(6.38,43.44)]、心可舒片[OR(95%CI)为4.67(3.26,6.68)]、乌灵胶囊[OR(95%CI)为4.65(2.48,8.72)]、冠心静胶囊[OR(95%CI)为2.93(1.37,2.64)]优于单纯西医常规疗法;联合振源胶囊的临床疗效优于联合心可舒片[OR(95%CI)为3.56(1.28,9.94)]、乌灵胶囊[OR(95%CI)为3.58(1.13,11.34)]、冠心静胶囊[OR(95%CI)为5.69(1.68,19.32)]或舒肝解郁胶囊[OR(95%CI)为9.29(2.79,30.96)];与联合舒肝解郁胶囊比较,联合心可舒片的临床疗效更好[OR(95%CI)为2.61(1.16,5.87)]。临床有效率的累积概率排序曲线图(SUCRA)排序为西医常规治疗联合振源胶囊(SUCRA=99.6)>联合心可舒片(SUCRA=67.5)>联合乌灵胶囊(SUCRA=65.0)>联合冠心静胶囊(SUCRA=41.6)>联合舒肝解郁胶囊(SUCRA=25.8)>西医常规治疗(SUCRA=0.5);在降低汉密尔顿抑郁量表(HAMD)评分方面,联合心可舒片[MD(95%CI)为-8.85(-14.16,-3.62)]优于西医常规治疗;在降低汉密尔顿焦虑量表(HAMA)评分方面,与西医常规疗法比较,联合乌灵胶囊[MD(95%CI)为-7.61(-14.82,-0.40)]、联合心可舒片[MD(95%CI)为-6.18(-9.78,-2.58)]疗效更佳,SUCRA排序为联合乌灵胶囊(SUCRA=82.8)>联合心可舒片(SUCRA=78.2);不良反应方面,西医联合5种中成药的安全性优于单用西医常规疗法。结论西医常规疗法Objective To evaluate the clinical efficacy of five different Chinese patent medicines combined with conventional western medicine therapy in the treatment of coronary heartdisease with anxiety and depression. Methods Randomized controlled trials (RCTs) of Chinesepatent medicine combined with conventional western medicine therapy and conventional westernmedicine therapy in the treatment of coronary heart disease with anxiety and depression wereretrieved from China Academic Journal Database (Wanfang Data), China Biomedical LiteratureService System (SinoMed), China National Knowledge Infrastructure (CNKI), Chinese Science andTechnology Journal Database (Chongqing VIP), Cochrane Library, PubMed and Embase databasesfrom January 1, 2010 to December 31, 2020. The Jadad score and Cochrane bias risk assessment toolwere used to assess the bias risk of the included literature. The RevMan 5.3, Stata 16.0 and GeMTC14.3 software were used for network meta-analysis. Results A total of 32 articles involving 3 494patients were included. In terms of clinical efficacy, the clinical efficacy of conventional westernmedicine combined with Zhenyuan Capsule [OR (95% CI)=16.64 (6.38, 43.44)], Xinkeshu Tablets [OR(95% CI)=4.67 (3.26, 6.68)], Wuling Capsule [OR (95% CI)=4.65 (2.48, 8.72)], Guanxinjing Capsule[OR (95% CI)=2.93 (1.37, 2.64)] weres better than that of conventional western medicine alone. Theclinical efficacy of combined Zhenyuan Capsule was better than that of combined Xinkeshu Tablets[OR (95% CI) =3.56 (1.28, 9.94)], Wuling Capsule [OR (95% CI) =3.58 (1.13, 11.34)], GuanxinjingCapsule [OR (95% CI)=5.69 (1.68, 19.32)] or Shugan Jieyu Capsule [OR (95% CI)=9.29 (2.79, 30.96)].Compared with Shugan Jieyu Capsule, Xinkeshu Tablets had better clinical efficacy [OR (95% CI)=2.61(1.16, 5.87)]. The SUCRA order of the effective rate of clinical efficacy was as follows conventionalwestern medicine treatment combined with Zhenyuan Capsule (SUCRA=99.6) >with Xinkeshu Tablets(SUCRA=67.5) > with Wuling Capsule (SUCRA=65.0) > with Guanxinji

关 键 词：中成药 冠心病 焦虑 抑郁 网状meta分析 

分 类 号：R541.4[医药卫生—心血管疾病] R749.4[医药卫生—内科学]