中成药辅助PCI术后治疗心肌梗死的网状meta分析

Network Meta-analysis of Traditional Chinese Medicine Combined with PCI for Myocardial Infarction

关键词:  中成药  心肌梗死  网状meta分析  随机对照实验

Key words:  Chinese medicine  myocardial infarction  network meta-analysis  randomized controlled trial

摘要:

目的 评价不同中成药辅助PCI治疗心肌梗死的临床疗效。方法 计算机检索CNKI、CBM、万方数据库、中国科学期刊数据库（VIP）、PubMed、EMBASE、The Cochrane Library、Web of Science等8个电子数据库，搜集关于中成药辅助PCI治疗心肌梗死的随机对照试验（randomized controlled trials，RCTs）。根据Cochrane标准对纳入RCTs的风险进行评估，并通过R 3.4.3和Stata 14软件进行网状meta分析。对不同中成药辅助PCI治疗心肌梗死患者的脑钠肽（brain natriuretic peptide，BNP）、不良心血管事件、左室射血分数进行比较。结果 纳入的16个研究包含了1 824例心肌梗死患者和4种比较常用的中成药（麝香保心丸、芪参益气滴丸、通心络胶囊、复方丹参滴丸）。网状meta分析显示，复方丹参滴丸、麝香保心丸和通心络胶囊能够降低不良心血管事件的发生率，差异具有统计学意义（P<0.05）；在改善心肌梗死患者左室射血分数方面，中成药辅助PCI的效果优于PCI治疗，差异具有统计学差异（P<0.05）；在降低心肌梗死患者BNP方面，中成药辅助PCI和PCI治疗差异无统计学意义。结论 现有证据表明，使用中成药辅助PCI治疗可以使心肌梗死患者受益。然而，受纳入研究数量和质量的限制，本研究结论尚需开展更多高质量研究予以证实。

Abstract:

OBJECTIVE To evaluate the clinical efficacy of different proprietary Chinese medicines in the treatment of myocardial infarction with PCI. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang Data, VIP and CNKI databases were searched for randomized controlled trials (RCTs) of traditional Chinese medicine combined with PCI for myocardial infarction. Assessment of risk of inclusion in RCTs according to Cochrane Handbook. Statistical analysis was performed by R 3.4.3 software and Stata 14 software. Comparison of brain natriuretic peptide (BNP), major adverse cardiovascular events, and left ventricular ejection fraction in patients with myocardial infarction treated with PCI combined with Chinese medicines. RESULTS The 16 studies included 1 824 patients with myocardial infarction and 4 kinds of Chinese medicines (Shexiang Baoxin pills, Qishen Yiqi Dropping pills, Tongxinluo capsules, Compound Danshen Dropping pills). Network meta-analysis showed that using Chinese medicine combined with PCI was superior to PCI in improving left ventricular ejection fractions, and the difference was statistically significant(P<0.05). Shexiang Baoxin pills, Tongxinluo capsules and Compound Danshen Dropping pills could reduce the risk of cardiovascular events, and the difference was statistically significant (P<0.05). There was no statistically significant difference in the treatment of PCI between patients with traditional Chinese medicine and PCI in reducing BNP in myocardial infarction patients. CONCLUSION The available evidence shows that Chinese medicine combined with PCI treatment can benefit patients with myocardial infarction. However, due to the limitations of the quantity and quality of the included studies, the conclusions of this study need to be confirmed by more high-quality studies.