中成药治疗非ST段抬高型急性冠脉综合征的网状Meta分析

目的:比较并评价中成药治疗非ST段抬高型急性冠脉综合征的疗效差异和在不同评价指标间的治疗优势。方法:选择中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Embase等主流医学数据库检索中成药治疗非ST段抬高型急性冠脉综合征随机对照试验,以中医证候积分疗效、心电图疗效、硝酸甘油减停率作为评价指标,并选用GRADEpro软件和Cochrane偏倚风险评估工具进行质量评估,GeMTC和Stata14.0软件进行网状Meta分析。结果:共纳入27篇随机对照试验和22种中成药。网状Meta分析结果显示,心脉通贴散联合芪参益气滴丸和常规西药、解毒通脉胶囊联合常规西药对于中医证候积分疗效较好;心痛舒胶囊联合常规西药对于改善心电图疗效较好;解毒通脉胶囊联合常规西药、养阴活血颗粒联合常规西药对于硝酸甘油减停率效果较好。结论:心脉通贴散、芪参益气滴丸、解毒通脉胶囊、心痛舒胶囊、养阴活血颗粒在非ST段抬高型急性冠脉综合征不同评价指标中具有一定治疗优势,但因受到文献质量限制,今后仍需高质量临床研究提供证据支持。

Network Meta-analysis of Chinese Medicine Preparations in the Treatment of Non-ST-elevation Acute Coronary Syndrome

Objective:To compare and evaluate the difference of efficiency of Chinese medicine preparations in the treatment of non-ST-segment elevation acute coronary syndrome and the advantages among different clinical indicators.Methods:Randomized controlled trials of Chinese medicine preparations in the treatment of non-ST-segment elevation acute coronary syndrome were searched based on the CNKI,WanFang,PubMed,et al.Clinical indicators including the efficiency of TCM syndrome score,improvement of ECG,and reduction of Nitroglycerin were analyzed through the software of GeMTC and STATA 14.0.The GRADEpro software and the Cochrane risk of bias assessment tool were used for quality assessment.Results:A total of 27 randomized controlled trials and 22 kinds of Chinese medicine preparations were included in the study.The results of network Meta-analysis showed that Xinmaitong Plaster combined Qishen Yiqi Dripping Pills and western medicine,and Jiedu Tongmai Capsules combined western medicine had a good effect on TCM syndrome score.Xintongshu Capsules combined western medicine had a good effect on ECG amelioration.Jiedu Tongmai Capsules combined western medicine and Yangyin Huoxue Granules combined western medicine had a good effect on the reduction of Nitroglycerin.Conclusion:Xinmaitong Plaster,Qishen Yiqi Dripping Pills,Jiedu Tongmai Capsules,Xintongshu Capsules and Yangyin Huoxue Granules had therapeutic advantages in different outcome indexes of non-ST-segment elevation acute coronary syndrome.However,high-quality clinical studies are still needed to provide evidence support in the future due to the limitation of literature quality.