疏肝理气活血法治疗冠心病合并抑郁的网状Meta分析  

The Effectiveness of Soothing Liver,Regulating Qi,and Activating Blood Method for Treating Coronary Heart Disease Combined with Depression:a Network Meta-analysis

作　　者：高璐[1] 孔德昭[2] 曹宇博 王思佳 张哲[1,2] GAO Lu;KONG Dezhao;CAO Yubo;WANG Sijia;ZHANG Zhe(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,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医院,沈阳110032

出　　处：《中西医结合心脑血管病杂志》2025年第4期503-512,共10页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：首届青年岐黄学者支持项目;辽宁省科学技术计划项目(No.2021JH2/10300021);辽宁中医药大学附属医院2021年度“育苗工程”项目(No.YM202130)。

摘　　要：目的:采用网状Meta分析比较不同疏肝理气活血类方药治疗冠心病合并抑郁的有效性和安全性。方法:检索中国知网(CNKI)、万方(WanFang Data)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、EMbase、The Cochrane Library和Web of Science数据库,搜集不同疏肝理气活血类方药治疗冠心病合并抑郁的随机对照试验(RCT)和抗抑郁药治疗冠心病合并抑郁的RCT,检索时限均为建库至2023年5月20日。筛选文献、提取资料和评价纳入研究的偏倚风险后,采用ADDIS 1.16.6和Stata/SE 15.0软件进行网状Meta分析,并进行证据质量GRADE分级及最小背景化框架,选取可信度较高的结果。结果:共纳入16个RCT,包括2种中药方剂,4种选择性5-羟色胺再摄取抑制剂(SSRIs)。网状Meta分析及最小背景化框架结果显示,降低汉密尔顿抑郁量表(HAMD)评分方面,冠心病治疗+帕罗西汀+血府逐瘀汤可能最佳,其次可能为冠心病治疗+帕罗西汀、冠心病治疗+氟西汀、冠心病治疗+舍曲林、冠心病治疗+西酞普兰;降低C反应蛋白(CRP)值方面,冠心病治疗+西酞普兰可能最佳,其次可能为冠心病治疗+帕罗西汀、冠心病治疗+疏肝解郁汤。结论:当前证据表明,冠心病治疗+帕罗西汀+血府逐瘀汤降低HAMD量表评分最佳,冠心病治疗+西酞普兰降低CRP值最佳,需根据病人具体情况及药物特点进行个体化治疗,但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objective:To compare the efficacy and safety of different prescriptions for regulating Qi and promoting blood circulation for treating coronary heart disease complicated with depression.Methods:The databases of CNKI,WanFang Data,VIP,SinoMed,PubMed,EMbase,The Cochrane Library,and Web of Science were retrieved to collect randomized controlled trials(RCTs)of the treatment of coronary heart disease complicated with depression with different liver-soothing,Qi-regulating and blood-activating prescriptions,as well as RCTs of antidepressants for treating coronary heart disease complicated with depression.The search time was from database establishment to May 20,2023.After screening the literature,extracting the data,and evaluating the risk of bias for the included studies,the mesh Meta analysis was performed using ADDIS 1.16.6 and Stata/SE 15.0 software,and the GRADE grading and minimum background framework with high confidence.Results:A total of 16 RCTs were included,including 2 TCM prescriptions and 4 selective serotonin reuptake inhibitors(SSRIs).Network Meta analysis and minimum background framework results showed that:for redution of the score of Hamilton Depression Scale(HAMD),coronary heart disease treatment+paroxetine+Xuefu Zhuyu Decoction might be the best therapy,followed by coronary heart disease treatment+paroxetine,coronary heart disease treatment+fluoxetine,coronary heart disease treatment+sertraline,coronary heart disease treatment+citalopram.In terms of reducing C-reactive protein(CRP)levels,the combination of coronary heart disease treatment and citalopram might be the most effective therapy,followed by coronary heart disease treatment+paroxetine,coronary heart disease treatment+Shugan Jieyu Decoction.Conclusion:Current evidence shows that the treatment of coronary heart disease+paroxetine+Xuefu Zhuyu Decoction could reduce the HAMD scale score.Coronary heart disease treatment+citalopram could reduce the CRP value most effectively.The individualized treatment based on specific situations and drug charact

关 键 词：冠心病 疏肝理气活血 中医药 抑郁 贝叶斯法 网状Meta分析 最小背景化框架 GRADE分级 

分 类 号：R277.7[医药卫生—中医学] R259