芪参益气滴丸改善急性心肌梗死后左室重构、心功能疗效及安全性的Meta分析
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摘要
目的系统评价常规西药加用芪参益气滴丸改善急性心肌梗死(AMI)后左室重构、心功能疗效及安全性。方法计算机检索中国知网(CNKI)、维普数据库(VIP)、万方数据库(WanFang)、中国生物医学文献数据库(CBMdisc)、PubMed和EMbase,收集符合条件的随机临床对照试验研究(RCT),并进行质量评价及有效资料提取,运用RevMan 5.3.5软件进行Meta分析。结果共纳入合格RCT10个,受试者1 052例,其中试验组529例,对照组523例。Meta分析结果显示:与单纯常规西药治疗比较,加用芪参益气滴丸可进一步提高AMI病人左室射血分数(LVEF)[加权均方差(WMD)=5.77,95%CI(3.68,7.86),P <0.01];减小左室舒张末期内径(LVEDD)[WMD=-3.46,95%CI(-4.90,-2.02),P <0.01]、左室收缩末期内径(LVESD)[WMD=-3.37,95%CI(-6.10,-0.65),P=0.02];可有效降低血清脑钠肽(BNP)[WMD=-44.96,95%CI(-70.04,-19.87),P <0.01]、N末端脑钠肽前体(NT-proBNP)[WMD=-61.65,95%CI(-91.77,-31.54),P <0.01];6 min步行距离差异无统计学意义[WMD=27.51,95%CI(-15.47,70.50),P=0.21];各研究期间未提示服药引起的不良反应及安全性指标异常。结论与常规西药治疗AMI比较,加用芪参益气滴丸可进一步提高疗效。
Objective To systematically evaluate the efficacy and safety of Qishen Yiqi dripping pill(QYDP)and conventional western medicine improving left ventricular remodeling and cardiac function after acute myocardial infarction(AMI).Methods By searching China National Knowledge Infrastructure(CNKI),VIP database,WanFang database,CBMdisc,PubMed and EMbase website,the eligible randomized clinical trials(RCT)were retrieved.The quality of literatures were evaluated,and effective information were obtained.Meta-analysis was performed by RevMan5.3.5 software.Conclusion Ten eligible RCTs studies,1 052 subjects,and529 test groups as well as 523 control groups were enrolled.The result of meta-analysis showed that compared with conventional western medicine treatment,QYDP plus conventional western medicine could improve left ventricular ejection fraction(LVEF)[WMD=5.77,95%CI(3.68,7.86),P <0.01],reduce left ventricular end-diastolic diameter(LVEDD)[WMD=-3.46,95% CI(-4.90,-2.02),P <0.01],reduce left ventricular endsystolic diameter(LVESD)[WMD=-3.37,95% CI(-6.10,-0.65),P =0.02],and effectively reduce brain natriuretic peptide(BNP)[WMD=-44.96,95% CI(-70.04,-19.87),P <0.01],N-terminal pro-brain natriuretic peptide(NT-proBNP)[WMD=-61.65,95% CI(-91.77,-31.54),P <0.01].There was no statistical significance in the effect of improving the six minutes walk distance for patients[WMD=27.51,95%CI(-15.47,70.50),P =0.21].There was no adverse reactions or abnormal safety indicators caused by medication suggested during the study period.Conclusion QYDP can further improve curative effect and the safety in patients with acute myocardial infarction compared with conventional western medicine.However,due to the limited quantity and quality of the included studies,the results suggest that rigorous further and high-quality and larger-scale clinical trials are needed.
Objective To systematically evaluate the efficacy and safety of Qishen Yiqi dripping pill(QYDP)and conventional western medicine improving left ventricular remodeling and cardiac function after acute myocardial infarction(AMI).Methods By searching China National Knowledge Infrastructure(CNKI),VIP database,WanFang database,CBMdisc,PubMed and EMbase website,the eligible randomized clinical trials(RCT)were retrieved.The quality of literatures were evaluated,and effective information were obtained.Meta-analysis was performed by RevMan5.3.5 software.Conclusion Ten eligible RCTs studies,1 052 subjects,and529 test groups as well as 523 control groups were enrolled.The result of meta-analysis showed that compared with conventional western medicine treatment,QYDP plus conventional western medicine could improve left ventricular ejection fraction(LVEF)[WMD=5.77,95%CI(3.68,7.86),P <0.01],reduce left ventricular end-diastolic diameter(LVEDD)[WMD=-3.46,95% CI(-4.90,-2.02),P <0.01],reduce left ventricular endsystolic diameter(LVESD)[WMD=-3.37,95% CI(-6.10,-0.65),P =0.02],and effectively reduce brain natriuretic peptide(BNP)[WMD=-44.96,95% CI(-70.04,-19.87),P <0.01],N-terminal pro-brain natriuretic peptide(NT-proBNP)[WMD=-61.65,95% CI(-91.77,-31.54),P <0.01].There was no statistical significance in the effect of improving the six minutes walk distance for patients[WMD=27.51,95%CI(-15.47,70.50),P =0.21].There was no adverse reactions or abnormal safety indicators caused by medication suggested during the study period.Conclusion QYDP can further improve curative effect and the safety in patients with acute myocardial infarction compared with conventional western medicine.However,due to the limited quantity and quality of the included studies,the results suggest that rigorous further and high-quality and larger-scale clinical trials are needed.
引文
[1]中国医师协会中西医结合医师分会,中国中西医结合学会心血管病专业委员会,中国中西医结合学会重症医学专业委员会,等.急性心肌梗死中西医结合诊疗指南[J].中国中西医结合杂志,2018,38(3):272-284.
[2]张俭,张敏州,郭立恒,等.中医药治疗急性心肌梗死的系统评价[J].中西医结合心脑血管病杂志,2011,9(5):513-515.
[3]廖鹏达.芪参益气滴丸对急性心肌梗死PCI后心功能影响多中心研究[D].广州中医药大学,2016.
[4]陈图刚,马战清,钟志英,等.芪参益气滴丸对急性心肌梗死后患者心功能和炎性因子的影响[J].江西医药,2011,46(8):687-689.
[5]宋红星,张杰,鲁召辉,等.芪参益气滴丸对老年急性心肌梗死患者PCI术后心脏康复的影响[J].齐齐哈尔医学院学报,2017,38(22):2649-2651.
[6]张武宁,彭雪梅,高晓东,等.芪参益气滴丸对首次急性ST段抬高型前壁心肌梗死病人PCI术后hs-CRP水平及短期心功能的影响[J].中西医结合心脑血管病杂志,2018,16(11):1543-1546.
[7]谢东霞,毛秉豫.芪参益气滴丸对心肌梗死后气虚血瘀证患者心室重构及心功能的影响[J].中国实验方剂学杂志,2011,17(1):192-195.
[8]李成伟,袁峰,李晓娟.芪参益气滴丸干预PCI术后急性前壁心肌梗死患者冠脉血流和左室功能的研究[J].中西医结合心脑血管病杂志,2014,12(12):1441-1443.
[9]杜武勋,朱明丹,冯利民,等.芪参益气滴丸干预急性心肌梗死后早期心室重构的临床研究[J].中国循证心血管医学杂志,2008,1(1):41-43.
[10]苏先华,邓佳丽.芪参益气滴丸在老年心肌梗死患者中的应用[J].中国中医急症,2016,25(11):2123-2125.
[11]王亚宽.西药联合芪参益气滴丸治疗急性心肌梗死44列临床观察[J].中国民族民间医药,2018,27(2):119-120.
[12]陈爽.芪参益气滴丸对急性心肌梗死再灌注后心功能及心室重构的临床疗效观察[D].南京:南京中医药大学,2015.
[13]陈可冀,张敏州,霍勇.急性心肌梗死中西医结合诊疗专家共识[J].中国中西医结合杂志,2014,34(4):389-395.
[14]魏聪聪,朱明丹,杜武勋,等.芪参益气滴丸临床应用研究进展[J].西部中医药,2011,24(10):102-106.
[2]张俭,张敏州,郭立恒,等.中医药治疗急性心肌梗死的系统评价[J].中西医结合心脑血管病杂志,2011,9(5):513-515.
[3]廖鹏达.芪参益气滴丸对急性心肌梗死PCI后心功能影响多中心研究[D].广州中医药大学,2016.
[4]陈图刚,马战清,钟志英,等.芪参益气滴丸对急性心肌梗死后患者心功能和炎性因子的影响[J].江西医药,2011,46(8):687-689.
[5]宋红星,张杰,鲁召辉,等.芪参益气滴丸对老年急性心肌梗死患者PCI术后心脏康复的影响[J].齐齐哈尔医学院学报,2017,38(22):2649-2651.
[6]张武宁,彭雪梅,高晓东,等.芪参益气滴丸对首次急性ST段抬高型前壁心肌梗死病人PCI术后hs-CRP水平及短期心功能的影响[J].中西医结合心脑血管病杂志,2018,16(11):1543-1546.
[7]谢东霞,毛秉豫.芪参益气滴丸对心肌梗死后气虚血瘀证患者心室重构及心功能的影响[J].中国实验方剂学杂志,2011,17(1):192-195.
[8]李成伟,袁峰,李晓娟.芪参益气滴丸干预PCI术后急性前壁心肌梗死患者冠脉血流和左室功能的研究[J].中西医结合心脑血管病杂志,2014,12(12):1441-1443.
[9]杜武勋,朱明丹,冯利民,等.芪参益气滴丸干预急性心肌梗死后早期心室重构的临床研究[J].中国循证心血管医学杂志,2008,1(1):41-43.
[10]苏先华,邓佳丽.芪参益气滴丸在老年心肌梗死患者中的应用[J].中国中医急症,2016,25(11):2123-2125.
[11]王亚宽.西药联合芪参益气滴丸治疗急性心肌梗死44列临床观察[J].中国民族民间医药,2018,27(2):119-120.
[12]陈爽.芪参益气滴丸对急性心肌梗死再灌注后心功能及心室重构的临床疗效观察[D].南京:南京中医药大学,2015.
[13]陈可冀,张敏州,霍勇.急性心肌梗死中西医结合诊疗专家共识[J].中国中西医结合杂志,2014,34(4):389-395.
[14]魏聪聪,朱明丹,杜武勋,等.芪参益气滴丸临床应用研究进展[J].西部中医药,2011,24(10):102-106.