口服中药治疗冠心病合并颈动脉粥样硬化疗效的贝叶斯网状Meta分析  

Bayesian Network Meta-analysis of Therapeutic Effect of Oral Chinese Patent Medicines on Coronary Artery Disease Complicated with Carotid Atherosclerosis

作　　者：于嘉祥 张瀚文[1] 王列[1] 石岩[1] 张文顺 张欢[1] 段盈竹 梁健 韩雪莹 曲超 胡哲 马俊杰 于睿[1] 于游[2] YU Jiaxiang;ZHANG Hanwen;WANG Lie;SHI Yan;ZHANG Wenshun;ZHANG Huan;DUAN Yingzhu;LIANG Jian;HAN Xueying;QU Chao;HU Zhe;MA Junjie;YU Rui;YU You(Liaoning University of Traditional Chinese Medicine(TCM),Shenyang 110847,China;The Second Affiliated Hospital of Liaoning University of TCM/Liaoning Academy of TCM,Shenyang 110866,China)

机构地区：[1]辽宁中医药大学,沈阳110847 [2]辽宁中医药大学附属第二医院/辽宁省中医药研究院,沈阳110866

出　　处：《中国实验方剂学杂志》2023年第22期163-170,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82274494);辽宁省科学技术计划项目(2020JH1/10100022);国家重点基础研究发展计划(973计划)项目(2013CB532004);辽宁省“兴辽英才计划”青年拔尖人才项目(XLYC2007121);辽宁省科技厅博士科研启动课题(2021-BS-183,2023-BS-141);中医脏象理论及应用教育部重点实验室2021年度开放基金项目(zyzx2109)。

摘　　要：目的:运用贝叶斯网状Meta分析比较不同中药治疗冠心病的疗效差异。方法:检索建库至2022年12月1日的中国知网、万方、维普共3个中文数据库和PubMed、Web of Science、Embase、Cochrane Library共4个英文数据库中关于口服中药治疗冠心病的随机对照试验,依据Cochrane系统评价手册中的策略评价纳入文献质量,首先用直接Meta分析方法对口服中药(包括中成药)同时保留常规西药与单独服用西药治疗冠心病(CAD)的指标:颈动脉厚度(IMT)、血管内皮功能、斑块积分、超敏C反应蛋白(hs-CRP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总有效率进行评价,然后运用贝叶斯网状Meta分析比较不同中药的疗效差异。结果:共纳入41篇文献直接Meta结果显示,口服中药同时保留常规西药在改善CAD的所有指标的疗效均优于单独使用西药治疗;贝叶斯网状Meta结果显示,在对总有效率的比较中,黄芪桂枝五物汤加味方、三七化瘀丸较其他中药干预方式优势明显;在IMT和斑块积分这两项指标的改善中,消斑化浊汤、益气通络方、软肝降脂胶囊、冠心疏通胶囊较其他中药干预方式优势明显;在对血脂的改善中,参芪柔脉合剂、软肝降脂胶囊、消斑化浊汤、七味三芎汤、三七化瘀丸较其他中药干预方式优势明显,以上药物核心功效为活血化瘀、化痰通脉。结论:口服中药同时保留常规西药冠心病疗效显著,临床医师可根据本次贝叶斯网状Meta分析结果结合患者的实际情况对异常明显的指标进行有针对的用药,可能产生更好的临床疗效。Objective:To compare the therapeutic effects of oral Chinese medicines(including Chinese patent medicines)on coronary artery disease(CAD)by the Bayesian network Meta-analysis.Method:The randomized controlled trials of treating CAD with oral Chinese medicines were retrieved from the China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,PubMed,Web of Science,Embase,and Cochrane Library from the inception to December 1,2022.The Cochrane risk of bias assessment tool was used to evaluate the quality of the included articles.The direct meta-analysis was performed to compare the performance of oral Chinese medicines alone and in combination with Western medicine in the treatment of CAD in terms of intimamedia thickness(IMT),vascular endothelial function,plaque score,hypersensitive C-reactive protein(hs-CRP),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),lowdensity lipoprotein cholesterol(LDL-C),and total response rate.Furthermore,the Bayesian network Metaanalysis was performed to compare the therapeutic effects of different Chinese medicines.Result:A total of 41 articles were included.The direct meta-analysis results showed that Chinese medicines combined with Western medicine outperformed Western medicine alone in recovering all the indicators of CAD.The Bayesian network meta-analysis yielded the following results.In terms of the total response rate,modified Huangqi Guizhi Wuwutang and Sanqi Huayu pills had obvious advantages over other Chinese medicines.In terms of IMT and plaque score,Xiaoban Huazhuo decoction,Yiqi Tongluo formula,Ruangan Jiangzhi capsules,and Guanxin Shutong capsules had obvious advantages over other Chinese medicines.In terms of blood lipid indicators,Shenqi Roumai mixture,Ruangan Jiangzhi capsules,Xiaoban Huazhuo decoction,Qiwei Sanxiong decoction,and Sanqi Huayu pills were superior to other Chinese medicines.The Chinese medicines above mainly had the functions of activating blood,resolving stasis,resolving phlegm,and dredging vessels.Conclusion:The com

关 键 词：中药 冠心病 颈动脉粥样硬化 贝叶斯网状Meta分析 优势 循证医学证据 

分 类 号：R284[医药卫生—中药学] R285[医药卫生—中医学] R289R287R22R2-031R33R24