电针治疗冠心病随机对照试验的有效性和安全性评价
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摘要
目的通过循证医学的方法系统评价电针治疗冠心病的有效性及安全性。方法以冠状动脉粥样硬化性心脏病、冠心病、心绞痛等,并含电针、针刺、针灸、针等为检索词,检索包括中国生物医学文献数据库,清华同方系列数据库(CNKI)之中国期刊全文数据库、中国优秀博硕士学位论文全文数据库、中国重要会议论文全文数据库,中国医用信息资源系统(维普),PubMed医学文献检索服务系统,MEDLINE生物医学文献数据库,Cochrane图书馆等数据库。结果纳入符合标准的文献共15篇,涉及研究12项,纳入患者1 006例。Meta分析结果显示电针可以改善患者的临床症状,改善心电图,减少硝酸甘油用量,降低血液黏稠度,改变血液流变学,增加血清超氧化物歧化酶(SOD)和一氧化氮(NO)含量,降低丙二醛(MDA)、脂氢过氧化物(LOOH)、内皮素(ET)及C反应蛋白的含量,并且优于对照组;在减少严重心血管事件的基础上,无明显不良反应。结论电针可以有效治疗冠心病,在改善症状、降低并发症方面优于常规药物治疗,但目前报道的电针治疗冠心病的文章质量良莠不齐,有待更多大样本、随机对照试验验证本文结论。
Objective To observe the efficacy and safety of electroacupuncture on the treatment of coronary heart disease(CHD) by evidence-based medicine. Methods Taking coronary atherosclerotic cardiopathy,CHD and angina as the key word,also contains electroacupuncture,needling,acupuncture and so on. The relevant articles about the randomized controlled trials were retrieved from Chinese Biomedicine Database,China Journal Fulltext Database(CJFD),Chinese Doctoral Dissertations & Master 's Theses Full-text Databases(CDMD),China Important Conference Papers Full-Text Database,China Medical Information Resources System(VIP),PubM ed,MEDLINE,Cochrane Library and so on. Results Totally 15 articles were included,involving 12 studies and 1 006 patients.Meta-analysis showed that electroacupuncture can effectively improve the clinical symptoms and ECG,decrease the dosage of nitroglycerin and the blood viscosity,and change the hemorheology,increase the serum SOD and NO,decrease MDA,LOOH,ET and c-reaction protein,with better effects than control group. The treatment fo electroacupuncture without obviously adverse reaction on the basis of the reduction of servere cardiovascular events. Conclusion Electroacupuncture has an effective treatment on CHD,and this therapy is superior to routine medicine with respect to the improvement of symptoms and reduction of complication. The quality of present articles about electroacupuncture treating CHD are spotty,the founding should be further certified by large-sample size and good-designed RCT.
Objective To observe the efficacy and safety of electroacupuncture on the treatment of coronary heart disease(CHD) by evidence-based medicine. Methods Taking coronary atherosclerotic cardiopathy,CHD and angina as the key word,also contains electroacupuncture,needling,acupuncture and so on. The relevant articles about the randomized controlled trials were retrieved from Chinese Biomedicine Database,China Journal Fulltext Database(CJFD),Chinese Doctoral Dissertations & Master 's Theses Full-text Databases(CDMD),China Important Conference Papers Full-Text Database,China Medical Information Resources System(VIP),PubM ed,MEDLINE,Cochrane Library and so on. Results Totally 15 articles were included,involving 12 studies and 1 006 patients.Meta-analysis showed that electroacupuncture can effectively improve the clinical symptoms and ECG,decrease the dosage of nitroglycerin and the blood viscosity,and change the hemorheology,increase the serum SOD and NO,decrease MDA,LOOH,ET and c-reaction protein,with better effects than control group. The treatment fo electroacupuncture without obviously adverse reaction on the basis of the reduction of servere cardiovascular events. Conclusion Electroacupuncture has an effective treatment on CHD,and this therapy is superior to routine medicine with respect to the improvement of symptoms and reduction of complication. The quality of present articles about electroacupuncture treating CHD are spotty,the founding should be further certified by large-sample size and good-designed RCT.
引文
[1]童延华,张振海,黄富强,等.电针结合西药治疗对冠心病心绞痛患者心功能的影响[J].湖北中医学院学报,2005,7(4):53-54.
[2]童利民,陆小平,代燕,等.电针配合西药对冠心病心绞痛患者血清超氧化物歧化酶与丙二醛含量的影响[J].湖北中医杂志,2005,27(12):12-13.
[3]黄富强,代燕,双露,等.电针结合西药治疗对冠心病心绞痛病人血液流变学的影响[J].中西医结合心血管病杂志,2005,3(12):1045-1046.
[4]童延华,童利民,徐桂冬,等.电针结合西药治疗冠心病心绞痛[J].中国康复,2005,20(5):276-277.
[5]李碧怡.电针背俞穴对无症状心肌缺血型冠心病动态心电图的研究[D].广州:广州中医药大学,2012.
[6]刁利红.电针、口服中药、针药结合对心肌缺血临床疗效及心肌能量代谢的实验研究[D].长沙:湖南中医学院,2004.
[7]黄洁.电针内关、口服复方丹参滴丸、针药结合治疗稳定型心绞痛的临床疗效对比观察[D].长沙:湖南中医学院,2004.
[8]徐派的.电针丰隆穴对急性冠脉综合征血脂水平及Hs CRP,CK,CK-MB的影响的临床研究[D].武汉:湖北中医药大学,2012.
[9]于雯.针刺内关穴对冠心病心绞痛患者血浆中NO、CGMP含量的影响[D].北京:北京中医药大学,2006.
[10]黄洁,严洁,常小荣,等.电针内关穴治疗稳定型心绞痛40例临床观察[J].湖南中医学院学报,2004,24(2):53-54.
[11]徐桂冬,童延华,黄富强,等.针药结合对冠心病心绞痛患者生存质量影响[J].针灸临床杂志,2006,22(2):16-17.
[12]李燕玲.不同频率电刺激内关穴治疗冠心病心绞痛的疗效观察[D].广州:广州中医药大学,2015.
[13]Lei Wang,Ning Zhang,Huaping Pan,et al.A Combination of Electro-Acupuncture and Aerobic Exercise Improves Cardiovascular Function in Patients with Coronary Heart Disease[J].J Chin Exp Cardiology,2015,(6):402.
[14]王宁,陈慧,卢圣锋,等.针刺内关对慢性稳定型心绞痛患者中性粒细胞与淋巴细胞比率的影响[J].中国针灸,2015,35(5):417-421.
[15]邹阳,刘广宣,周小泉.冠心病心肌缺血患者电针及药物治疗后载脂蛋白的变化[J].贵州医药,2005,29(12):1079-1080.
[16]Schulz KF,Grimes DA.Allocation concealment in randomized trials:defending against Deciphering[J].Lancet,2002,359(9306):614-618.
[17]Schulz KF,Altman DG,Moher D,et al.CONSORT2010 statement:updated guidelines for reporting parallel group randomised trials[J].BMJ,2010,340:c332.
[2]童利民,陆小平,代燕,等.电针配合西药对冠心病心绞痛患者血清超氧化物歧化酶与丙二醛含量的影响[J].湖北中医杂志,2005,27(12):12-13.
[3]黄富强,代燕,双露,等.电针结合西药治疗对冠心病心绞痛病人血液流变学的影响[J].中西医结合心血管病杂志,2005,3(12):1045-1046.
[4]童延华,童利民,徐桂冬,等.电针结合西药治疗冠心病心绞痛[J].中国康复,2005,20(5):276-277.
[5]李碧怡.电针背俞穴对无症状心肌缺血型冠心病动态心电图的研究[D].广州:广州中医药大学,2012.
[6]刁利红.电针、口服中药、针药结合对心肌缺血临床疗效及心肌能量代谢的实验研究[D].长沙:湖南中医学院,2004.
[7]黄洁.电针内关、口服复方丹参滴丸、针药结合治疗稳定型心绞痛的临床疗效对比观察[D].长沙:湖南中医学院,2004.
[8]徐派的.电针丰隆穴对急性冠脉综合征血脂水平及Hs CRP,CK,CK-MB的影响的临床研究[D].武汉:湖北中医药大学,2012.
[9]于雯.针刺内关穴对冠心病心绞痛患者血浆中NO、CGMP含量的影响[D].北京:北京中医药大学,2006.
[10]黄洁,严洁,常小荣,等.电针内关穴治疗稳定型心绞痛40例临床观察[J].湖南中医学院学报,2004,24(2):53-54.
[11]徐桂冬,童延华,黄富强,等.针药结合对冠心病心绞痛患者生存质量影响[J].针灸临床杂志,2006,22(2):16-17.
[12]李燕玲.不同频率电刺激内关穴治疗冠心病心绞痛的疗效观察[D].广州:广州中医药大学,2015.
[13]Lei Wang,Ning Zhang,Huaping Pan,et al.A Combination of Electro-Acupuncture and Aerobic Exercise Improves Cardiovascular Function in Patients with Coronary Heart Disease[J].J Chin Exp Cardiology,2015,(6):402.
[14]王宁,陈慧,卢圣锋,等.针刺内关对慢性稳定型心绞痛患者中性粒细胞与淋巴细胞比率的影响[J].中国针灸,2015,35(5):417-421.
[15]邹阳,刘广宣,周小泉.冠心病心肌缺血患者电针及药物治疗后载脂蛋白的变化[J].贵州医药,2005,29(12):1079-1080.
[16]Schulz KF,Grimes DA.Allocation concealment in randomized trials:defending against Deciphering[J].Lancet,2002,359(9306):614-618.
[17]Schulz KF,Altman DG,Moher D,et al.CONSORT2010 statement:updated guidelines for reporting parallel group randomised trials[J].BMJ,2010,340:c332.