口服中成药联合常规西药治疗微血管性心绞痛的Meta分析  

Meta-analysis of Oral Chinese Patent Medicine Combined with Conventional Western Medicine in the Treatment of Microvascular Angina

作　　者：余林波 周鹍[2] 肖华丽 黄丽君 惠嫣然 黄炫淳 林谦 YU Linbo;ZHOU Kun;XIAO Huali;HUANG Lijun;HUI Yanran;HUANG Xuanchun;LIN Qian(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院,北京100078 [3]北京中医药大学东直门医院

出　　处：《中西医结合心脑血管病杂志》2023年第6期969-977,共9页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金面上项目(No.81874385)。

摘　　要：目的:系统评价口服中成药治疗微血管性心绞痛(MVA)的疗效及安全性。方法:计算机检索中国知网(CNKI)、万方(WanFang Data)、维普(VIP)、中国生物医学文献数据库(SinoMed)、PubMed、Web of Science、the Cochrane Library、EMbase等数据库,收集口服中成药联合常规西药治疗MVA的随机对照试验(RCTs),检索时限为建库至2022年4月。应用Cochrane协作网偏倚风险评估工具对纳入研究进行质量评价,使用RevMan 5.4和Stata 12.0软件进行数据分析。结果:共纳入19项研究,涉及1555例病人,试验组802例,对照组753例。Meta分析结果显示,与对照组相比,试验组心绞痛症状减轻[RR=1.17,95%CI(1.09,1.25),P<0.00001],心电图(ECG)运动试验持续时间延长[MD=53.88,95%CI(38.24,69.51),P<0.00001],静息ECG疗效提高[RR=1.24,95%CI(1.09,1.41),P=0.001],血清一氧化氮(NO)浓度升高[MD=14.43,95%CI(6.49,22.37),P=0.0004],血清内皮素1(ET-1)浓度降低[MD=-20.34,95%CI(-27.32,-13.37),P<0.00001],血清超敏C反应蛋白(hs-CRP)浓度降低[MD=-2.01,95%CI(-3.23,-0.78),P=0.001],且不增加不良反应发生率。结论:现在证据表明,在常规西药治疗的基础上口服中成药能减轻MVA病人临床症状,改善心肌缺血及冠状动脉微血管内皮功能,具有较好的安全性,但本研究纳入文献质量整体较低,结论仍需多中心、大样本的随机对照试验验证。Objective:To evaluate the efficacy and safety of oral Chinese patent medicine in the treatment of microvascular angina(MVA).Methods:CNKI,WanFang Data,VIP,SinoMed,PubMed,Web of Science,the Cochrane Library,and EMbase were searched by computer to collect the randomized controlled trials(RCTs)of oral Chinese patent medicine combined with conventional western medicine in the treatment of MVA,and the retrieval time was from the database establishment to April 2022.The quality of the included studies was evaluated using the bias risk assessment tool of Cochrane Collaboration,and RevMan 5.4 and Stata 12.0 software were used to analyze the data.Results:A total of 1555 patients were included in 19 studies,with 802 patients in the experimental group and 753 patients in the control group.Meta-analysis showed that compared with control group,the angina symptoms in experimental group were improved[RR=1.17,95%CI(1.09,1.25),P<0.00001],the time of duration on the electrocardiogram(ECG)exercise test was prolonged[MD=53.88,95%CI(38.24,69.51),P<0.00001],the resting ECG efficacy was improved[RR=1.24,95%CI(1.09,1.41),P=0.001],the concentration of serum nitric oxide(NO)was increased[MD=14.43,95%CI(6.49,22.37),P=0.0004],the concentration of serum endothelin-1(ET-1)was decreased[MD=-20.34,95%CI(-27.32,-13.37),P<0.00001],the concentration of serum high-sensitivity C-reactive protein(hs-CRP)was decreased[MD=-2.01,95%CI(-3.23,-0.78),P=0.001],and the incidence of adverse reaction did not increased.Conclusion:Available evidence suggests that addition of oral Chinese patent medicine on the basis of conventional western medicine treatment can alleviate the clinical symptoms of MVA and improve myocardial ischemia and coronary microvascular endothelial function,with better safety.However,the quality of the included studies is poor,and the conclusion still need to be verified by multi-center,large-sample randomized controlled trials.

关 键 词：微血管性心绞痛 心脏X综合征 常规西医治疗 中成药 疗效 安全性 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]