摘要
基于网状Meta分析比较不同中成药治疗慢性肺源性心脏病的疗效与安全性。计算机检索中国知网(CNKI)、维普(VIP)、万方(Wanfang)、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、EMbase和Cochrane Library数据库收录的中成药治疗慢性肺源性心脏病的随机对照试验(RCT)。检索时限为建库至2023年12月。根据Cochrane偏倚风险评估工具对纳入文献进行质量评价,采用RevMan 5.4和Stata 17.0软件绘制风险偏倚和网状Meta分析。最终纳入95篇RCTs,总样本量8787例,涉及11种中成药。网状Meta分析显示,(1)心功能改善临床总有效率方面,累计概率排名曲线下面积(SUCRA)排序前3的是稳心颗粒+常规西医、通心络胶囊+常规西医、芪参益气滴丸+常规西医;(2)提升第1秒用力呼气容积(FEV1)方面,SUCRA排序前3的是丹葶肺心颗粒+常规西医、通心络胶囊+常规西医、补肺活血胶囊+常规西医;(3)提高1秒率(FEV1/FVC%)方面,SUCRA排序前3的是芪苈强心胶囊+常规西医、麝香保心丸+常规西医、芪参益气滴丸+常规西医;(4)改善血氧分压(PaO_(2))方面,SUCRA排序前3的是芪苈强心胶囊+常规西医、芪参益气滴丸+常规西医、麝香保心丸+常规西医;(5)降低血二氧化碳分压(PaCO_(2))方面,SUCRA排序前3的是通心络胶囊+常规西医、芪参益气滴丸+常规西医、麝香保心丸+常规西医;(6)增加左心室射血分数(LVEF)方面,SUCRA排序前3的是补肺活血胶囊+常规西医、芪参益气滴丸+常规西医、麝香保心丸+常规西医;(7)降低脑钠肽(BNP)方面,SUCRA排序前3的是复方丹参滴丸+常规西医、芪苈强心胶囊+常规西医、通心络胶囊+常规西医;(8)改善红细胞压积方面,SUCRA排序前3的是芪参益气滴丸+常规西医、复方丹参滴丸+常规西医、通心络胶囊+常规西医。安全性方面,26篇RCTs报告了不良反应,主要涉及循环和消化系统。结果表明,中成药联合常规西医可增强慢性肺源性心脏病的临床疗效。鉴于纳入文献质量和数量参差不齐,缺乏中成药间的直接比较,以上结论还需更多多中心、大样本、高质量的研究加以验证。
Network Meta-analysis was performed to compare the efficacy and safety of Chinese patent medicines in treating chronic pulmonary heart disease.CNKI,VIP,Wanfang,SinoMed,PubMed,Web of Science,EMbase,and Cochrane Library were searched for randomized controlled trial(RCT)of treating chronic pulmonary heart disease with Chinese patent medicines with the time interval from inception to December 2023.The Cochrane risk-of-bias tool was used for quality assessment of the included articles.RevMan 5.4 and Stata 17.0 were employed to establish the risk of bias map and perform the network Meta-analysis,respectively.Ultimately,a total of 95 RCTs involving 8787 cases and 11 different Chinese patent medicines were included.Network Meta-analysis yielded the following results based on the surface under the cumulative ranking curve(SUCRA).(1)In terms of cardiac function improves clinical total effective rate,SUCRA the top three were Wenxin Granules+conventional western medicine,Tongxinluo Capsules+conventional western medicine,and Qishen Yiqi Dropping Pills+conventional western medicine.(2)For improving forced expiratory volume in the first se-cond(FEV1),SUCRA the top three were Danting Feixin Granules+conventional western medicine,Tongxinluo Capsules+conventional western medicine,and Bufei Huoxue Capsules+conventional western medicine.(3)Regarding increasing the FEV1/forced vital capacity(FVC%)value,SUCRA the top three were Qili Qiangxin Capsules+conventional western medicine,Shexiang Baoxin Pills+conventional western medicine,and Qishen Yiqi Dropping Pills+conventional western medicine.(4)In terms of increasing the partial pressure of oxygen(PaO_2),SUCRA the top three were Qili Qiangxin Capsules+conventional western medicine,Qishen Yiqi Dropping Pills+conventional western medicine,and Shexiang Baoxin Pills+conventional western medicine.(5)In terms of reducing the partial pressure of carbon dioxide(PaCO_2),SUCRA the top three were Tongxinluo Capsules+conventional western medicine,Qishen Yiqi Dropping Pills+conventional western medicine,and Shexiang Baoxin Pills+conventional western medicine.(6)In terms of increasing left ventricular ejection fraction(LVEF),SUCRA the top three were Bufei Huoxue Capsules+conventional western medicine,Qishen Yiqi Dropping Pills+conventional western medicine,and Shexiang Baoxin Pills+conventional western medicine.(7)In terms of decreasing brain natriu-retic peptide(BNP),SUCRA the top three were Compound Danshen Dropping Pills+conventional western medicine,Qili Qiangxin Capsules+conventional western medicine,and Tongxinluo Capsules+conventional western medicine.(8)In terms of improving the hematocrit level,SUCRA the top three were Qishen Yiqi Dropping Pills+conventional western medicine,Compound Danshen Dropping Pills+conventional western medicine,and Tongxinluo Capsules+conventional western medicine.In terms of safety,26 RCTs reported adverse reactions,which primarily involved the circulatory and digestive systems.The combination of Chinese patent medicines with conventional western medicine has demonstrated enhanced therapeutic effects on chronic pulmonary heart disease.However,due to the varying quality and sample sizes of included studies and the absence of direct comparisons between Chinese patent medicines,the conclusions should be further validated by multicenter studies with larger sample sizes and higher methodological rigor.
作者
吴文俊
张赤道
卫靖靖
李雪
彭广操
王新陆
于瑞
朱明军
WU Wen-jun;ZHANG Chi-dao;WEI Jing-jing;LI Xue;PENG Guang-cao;WANG Xin-lu;YU Rui;ZHU Ming-jun(Department of Cardiovascular Diseases,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Henan University of Chinese Medicine,Zhengzhou 450000,China)
出处
《中国中药杂志》
CAS
CSCD
北大核心
2024年第14期3936-3951,共16页
China Journal of Chinese Materia Medica
基金
国家自然科学基金重点项目(82030120)
国家中医药管理局中医药传承与创新“百千万”人才工程(岐黄工程)岐黄学者项目(国中医药人教函[2021]203号)
河南省中医药科学研究专项(2022JDZX012,2024ZY3027)。
关键词
中成药
慢性肺源性心脏病
网状Meta分析
随机对照试验
Chinese patent medicine
chronic pulmonary heart disease
network Meta-analysis
randomized controlled trial
