麝香保心丸治疗冠心病心绞痛的系统评价再评价

目的通过再评价纳入随机对照试验的麝香保心丸治疗冠心病心绞痛的系统评价,对证据进行再评价研究。方法计算机检索建库至2019年12月31日Cochrane Library、EMbase、PubMed、CNKI、CBM、VIP和WanFang医学数据库,筛选符合标准的麝香保心丸治疗冠心病心绞痛的系统评价。2位作者对纳入的研究独立进行资料收集,对各系统评价的结局指标进行描述性评价,并进行报告质量、方法学质量和证据等级的评价。报告质量评价用PRISMA声明,方法学质量评价采用AMSTAR2量表,证据质量评价采用GRADE工具。结果共纳入11篇系统评价,结论显示麝香保心丸治疗冠心病心绞痛对心绞痛、心电图等结局指标的改善均有优势。PRISMA评价结果显示10篇报告质量为中等,1篇报告质量较低;AMSTAR2评价结果显示,所有报告均为极低质量;GRADE分级结果显示,5项结局指标证据质量为低级,其余均为极低,导致降级的最主要原因为研究的局限性和发表偏倚。结论麝香保心丸治疗冠心病心绞痛有一定的临床疗效,但当前针对麝香保心丸治疗冠心病心绞痛的系统评价的方法学质量总体不高,结论的证据水平普遍较低,整体报告质量还有待提高,今后的临床试验和系统评价均应严格遵循循证医学科研设计要求,以提供更高质量的证据。

A Systematic Reviews of Shexiang Baoxin Pills for the Treatment of Coronary Heart Disease-Angina Pectoris

Objective:To evaluate the evidence of the efficacy of Baoxin Pills for the treatment of angina pectoris by overviewing the systematic reviews(SRs).Methods:The Cochrane library,EMbase,PubMed,CNKI,VIP,CBM and Wanfang databases were searched to collect the SRs from the inception to December 31 st,2019.Two reviewers independently screened literature and extracted data,then PRISMA statement and AMSTAR tool were used to assess the reporting quality and the methodological quality of included studies;the GRADE tool was used to grade the evidence quality of outcomes included in the SRs.Results:A total of 11 articles were included in the study.Based on the included studies,Shexiang Baoxin Pills were effective in the treatment of angina pectoris in the improvement of symptoms,ECG and other outcomes.The results of PRISMA assessment showed that 10 SRs were rated as moderate quality and 1 was rated as very low quality.The results of AMSTAR 2 assessment showed that all SRs were of very low quality.The GRADE results showed that 5 outcomes were graded as"low quality",while the others were"very low quality".The reason for these results were mainly owing to research limitations and publication bias.Conclusion:Shexiang Baoxin Pills is effective in the treatment of angina pectoris.But the methodological quality assessment for the treatment of angina with Shexiang Baoxin Pills is generally not high,the level of evidence for the outcomes is generally low,and the reporting quality needs to be improved.So a large amount of high quality experiments and strict designed SRs are needed in the future to provide higherquality evidences for the clinicians.