中药注射液治疗扩张型心肌病的网状Meta分析  

Network Meta-analysis of comparative efficacy of Chinese medicine injections for dilated cardiomyopathy

作　　者：陶诗怡 于林童 李军[2] 李永浩 黄炫淳[2] 薛甜甜 杨德爽 郑超楠 TAO Shi-yi;YU Lin-tong;LI Jun;LI Yong-hao;HUANG Xuan-chun;XUE Tian-tian;YANG De-shuang;ZHENG Chao-nan(Beijing University of Chinese Medicine,Beijing 100029,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院广安门医院,北京100053 [3]中日友好医院,北京100029

出　　处：《中国中药杂志》2024年第22期6198-6213,共16页China Journal of Chinese Materia Medica

基　　金：中央高水平中医医院临床科研业务费专项(HLCMHPP2023065);中国中医科学院科技创新工程重大攻关项目(CI2021A00902)。

摘　　要：基于贝叶斯网状Meta分析评估不同中药注射液治疗扩张型心肌病(dilated cardiomyopathy,DCM)的有效性及安全性。计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、EMbase、Cochrane Library、ProQuest、Cochrane临床试验中心注册数据库、ClinicalTrials.gov,自建库至2024年1月31日中药注射液治疗DCM的随机对照试验(randomized controlled trial,RCT)。根据Cochrane系统评价手册偏倚风险评价工具评估文献质量,通过GRADE系统评价证据质量。采用Stata 16.0、RevMan 5.4软件进行Meta分析。最终纳入57篇RCTs,样本量4812例,涉及6种中药注射液,包含6个结局指标。网状Meta分析显示,①提高临床总有效率方面,除参芪扶正注射液+常规西药外,其余5种中药注射液联合常规西药均优于常规西药,以心脉隆注射液+常规西药效果最佳;②改善左室射血分数方面,6种中药注射液联合常规西药均优于常规西药,以生脉注射液+常规西药疗效最佳;③降低左室舒张末期内径方面,除生脉注射液+常规西药外,参附注射液+常规西药、参麦注射液+常规西药、黄芪注射液+常规西药、心脉隆注射液+常规西药均优于常规西药,以黄芪注射液+常规西药疗效最佳;④降低脑钠肽方面,黄芪注射液+常规西药、参附注射液+常规西药、参麦注射液+常规西药均优于常规西药,以黄芪注射液+常规西药疗效更优;⑤提高6 min步行试验方面,参麦注射液+常规西药优于常规西药;⑥改善心输出量方面,除参附注射液+常规西药外,参麦注射液+常规西药、生脉注射液+常规西药、心脉隆注射液+常规西药、参芪扶正注射液+常规西药均优于常规西药,以参麦注射液+常规西药疗效更优;⑦安全性方面,试验组与对照组均报道了不同程度的不良事件,差异无统计学意义(P=0.24)。结果表明,中药注射液联合常规西药治疗DCBayesian network Meta-analysis was conducted to assess the efficacy and safety of different Chinese medicine injections for dilated cardiomyopathy(DCM).CNKI,Wanfang,VIP,SinoMed,PubMed,Web of Science,EMbase,Cochrane Library,ProQuest,Cochrane Central Register of Controlled Trials,ClinicalTrials.gov were searched for the randomized controlled trial(RCT)from the inception to January 2024.The quality of the included RCT was evaluated using the Cochrane′s risk of bias assessment tool,and the quality of evidence for outcomes was assessed by GRADE.Stata 16.0 and RevMan 5.4 softwares were used for Meta-analysis.A total of 57 RCTs involving 4812 subjects,6 Chinese medicine injections and 6 outcome indicators were included.Bayesian network Meta-analysis indicated that:①In terms of increasing clinical total effectiveness rate,except Shenqi Fuzheng Injection+conventional western medicine,other 5 Chinese medicine injections combined with conventional western medicine outperformed conventional western medicine alone,and Xinmailong Injection+conventional western medicine had the best effect.②In terms of improving left ventricular ejection fraction,all of the 6 Chinese medicine injections combined with conventional western medicine were superior to conventional western medicine alone,and Shengmai Injection+conventional western medicine had the highest likelihood of being the best intervention.③On account of reducing left ventricular end-diastolic dimension,Shenfu Injection+conventional western medicine,Shenmai Injection+conventional western medicine,Huangqi Injection+conventional western medicine,and Xinmailong Injection+conventional western medicine outperformed conventional western medicine alone except Shengmai Injection+conventional western medicine,and Huangqi Injection+conventional western medicine had the highest probability of being the best treatment.④In terms of decreasing BNP,Huangqi Injection+conventional western medicine,Shenfu Injection+conventional western medicine,and Shenmai Injection+conventional weste

关 键 词：扩张型心肌病 中药注射液 网状Meta分析 随机对照试验 

分 类 号：R259[医药卫生—中西医结合] G353.1[医药卫生—中医内科学]