8种中医经典方剂治疗慢性心力衰竭的网状Meta分析  

Network Meta-analysis of Eight Classical Chinese Medicine Prescriptions in Treating Chronic Heart Failure

作　　者：敖玉涵 苏嘉楠 李京[1,2] 刘宁[1,2] AO Yuhan;SU Jia′nan;LI Jing;LIU Ning(Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China)

机构地区：[1]辽宁中医药大学,沈阳110032 [2]辽宁中医药大学附属医院,沈阳110032

出　　处：《世界中医药》2024年第14期2128-2139,共12页World Chinese Medicine

基　　金：辽宁省应用基础研究计划项目(2023JH2/101600028);辽宁省科技计划联合计划应用基础研究项目(2023JH2/101700229)。

摘　　要：目的:对8种治疗慢性心力衰竭(CHF)的经典中药方剂进行分析,系统评价经典中药方剂联合西医常规疗法在CHF治疗中的有效性及安全性。方法:按照循证医学要求,全面检索国内外数据库近5年发表的相关临床研究。采用RevMan 5.4及Stata17.0软件进行数据分析。结果:共纳入29篇文献,涵盖2 552例患者(观察组1 277例,对照组1 275例)。网状Meta分析结果显示,8种中药方剂干预联合西医常规治疗(WM)能有效提高慢性心力衰竭的临床有效率,同时改善相关理化指标,其中参附汤+苓桂术甘汤+WM是提高治疗有效率的最佳选择;苓桂术甘汤+WM是提高6 min步行距离(6MWD),降低脑钠肽(BNP)、左室收缩末期内径(LVESD)及左室收舒张期内径(LVEDD)的最佳选择;真武汤+葶苈大枣泻肺汤+WM是降低氨基端前脑钠素(NT-proBNP)的最佳选择;参附汤+苓桂术甘汤+WM是通过左室射血分数(LVEF)的最佳选择;茯苓四逆汤+WM是降低不良反应的最佳选择。结论:8种中药方剂干预联合西医常规治疗在治疗CHF方面各有所长,可根据实际情况选择对应方剂治疗。然而,受纳入研究的限制,其结论仍需开展更多大样本、多中心、高质量的随机对照试验予以验证。Objective:To analyze eight classical Chinese medicine prescriptions in treating chronic heart failure(CHF) and systematically evaluate the effectiveness and safety of the above prescriptions combined with conventional western medicine(WM) in the treatment of CHF.Methods:According to the requirements of evidence-based medicine,the relevant clinical studies published in Chinese and foreign databases in the past five years were comprehensively searched,and RevMan5.4 and Stata17.0 software were used for data analysis.Results:A total of 29 articles were included,involving 2 552 patients(1 277 cases in the treatment group and 1 275 cases in the control group).The results of the network meta-analysis show that the intervention of the eight prescriptions combined with conventional WM can effectively improve the clinical effective rate in the treatment of CHF and related physicochemical indexes.Specifically,Shenfu Decoction+Linggui Zhugan Decoction+WM is the best choice to improve the effective rate,and Linggui Zhugan Decoction+WM is the best choice to improve the 6-minute walk distance(MWD) and reduce the brain natriuretic peptide(BNP),left ventricular end systolic diameter(LVESD),and left ventricular end diastolic diameter(LVEDD).Zhenwu Decoction+Tingli Dazao Xiefei Decoction+WM is the best choice to reduce N-terminal pro-brain natriuretic peptide(NT-pro BNP),and Shenfu Decoction+Linggui Zhugan Decoction+WM is the best choice for left ventricular ejection fraction(LVEF).Fuling Sini Decoction+WM is the best choice to reduce adverse reactions.Conclusion:The intervention of eight Chinese medicine prescriptions combined with conventional WM has its own advantages in treating CHF,so the corresponding prescription can be selected according to the actual situation.However,due to the limitation of included research,its conclusions still need to be verified by more large-sample,multi-center,and high-quality randomized controlled trials(RCTs).

关 键 词：中药方剂 慢性心力衰竭 喘证 心水 水肿 经方 网状Meta分析 

分 类 号：R289[医药卫生—方剂学] R541[医药卫生—中药学]