美托洛尔联合麝香保心丸治疗不稳定型心绞痛的Meta分析
|
摘要
目的综合评价美托洛尔联合麝香保心丸治疗不稳定型心绞痛的临床疗效和安全性。方法计算机检索Cochrane图书馆、PubMed、Embase、中国期刊全文数据库(CNKI)、中文期刊全文数据库(VIP)和万方数据知识服务平台(Wanfang),查找所有美托洛尔联合麝香保心丸治疗不稳定型心绞痛的随机对照试验(RCT),检索时限均为数据库建库至2018年9月。由2名研究人员独立按照纳入和排除标准选择文献并提取资料,交叉核对并进行方法学质量评估,应用RevMan 5.3软件对所提取的数据进行汇总分析。根据对照组是否使用美托洛尔进行亚组分析。结果共纳入31项研究,2845例患者。研究结果表明与对照组相比,美托洛尔联合麝香保心丸组患者的临床有效率显著升高(RR=1.27,95%CI:1.23～1.31);心绞痛发作频率显著降低(SMD=-7.71,95%CI:-8.59～-5.74);心绞痛持续时间显著降低(SMD=-3.88,95%CI:-4.65～-3.11);发作间期显著延长(MD=2.75 d,95%CI:2.63～2.87 d)。美托洛尔联合麝香保心丸组与对照组的不良反应发生率相似,亚组分析结果与整体结果类似。结论现有证据表明,美托洛尔联合麝香保心丸具有协同作用,能够明显提高临床疗效,临床应用价值高,是一种治疗不稳定型心绞痛的良好选择。
Objective To comprehensively evaluate the efficacy and safety of metoprolol combined with Shexiang Baoxin Pills(麝香保心丸) on unstable angina. Methods To collect randomized controlled trials(RCTs) which used metoprolol and Shexiang Baoxin Pills(麝香保心丸) in treating unstable angina, we electronically searched the databases of Cochrane Library, PubMed,Embase, CNKI, VIP, and Wan Fang from the inception of databases to September, 2018. Two researchers independently selected literature and extracted data based on inclusion and exclusion criteria, cross-checked and assessed the methodological quality.RevMan5.3 software was used to collect and analyze the extracted data. Subgroup analysis was made according to whether used metoprolol in the control group. Results There were 31 RCTs involving 2845 cases of unstable angina in our meta analysis. The results of meta-analysis showed that compared with the control group, metoprolol combined with Shexiang Baoxin Pills(麝香保心丸) has significantly increased patients' clinical effective rate(RR=1.27, 95% CI : 1.23-1.31), significantly decreased occurrence rate(SMD=-7.71, 95% CI :-8.59--5.74) and duration of angina(SMD=-3.88, 95% CI :-4.65--3.11). Interictal stage(MD=2.75 d, 95% CI :2.63-2.87 d) was significantly prolonged. The adverse reaction rate was similar between experimental group and control group, and the results of subgroup analysis were similar to overall results. Conclusion Based on present evidence, metoprolol and Shexiang Baoxin Pills(麝香保心丸) have synergistic effects. The therapy obviously improve the clinical effects and have high clinical application value, which is a good choice for the treatment of unstable angina.
Objective To comprehensively evaluate the efficacy and safety of metoprolol combined with Shexiang Baoxin Pills(麝香保心丸) on unstable angina. Methods To collect randomized controlled trials(RCTs) which used metoprolol and Shexiang Baoxin Pills(麝香保心丸) in treating unstable angina, we electronically searched the databases of Cochrane Library, PubMed,Embase, CNKI, VIP, and Wan Fang from the inception of databases to September, 2018. Two researchers independently selected literature and extracted data based on inclusion and exclusion criteria, cross-checked and assessed the methodological quality.RevMan5.3 software was used to collect and analyze the extracted data. Subgroup analysis was made according to whether used metoprolol in the control group. Results There were 31 RCTs involving 2845 cases of unstable angina in our meta analysis. The results of meta-analysis showed that compared with the control group, metoprolol combined with Shexiang Baoxin Pills(麝香保心丸) has significantly increased patients' clinical effective rate(RR=1.27, 95% CI : 1.23-1.31), significantly decreased occurrence rate(SMD=-7.71, 95% CI :-8.59--5.74) and duration of angina(SMD=-3.88, 95% CI :-4.65--3.11). Interictal stage(MD=2.75 d, 95% CI :2.63-2.87 d) was significantly prolonged. The adverse reaction rate was similar between experimental group and control group, and the results of subgroup analysis were similar to overall results. Conclusion Based on present evidence, metoprolol and Shexiang Baoxin Pills(麝香保心丸) have synergistic effects. The therapy obviously improve the clinical effects and have high clinical application value, which is a good choice for the treatment of unstable angina.
引文
[1] Tegn N, Abdlnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients age 80 years or older with non-ST-elevation myocardial infarction or unstable angina pecloris(After Eighty study):an open-label randomized controlled tria[J].Lancet 2016, 387(10023):1057-1065.
[2]谢辉.麝香保心丸联合西药治疗冠心病不稳定型心绞痛随机平行对照研究[J].实用中医内科杂志, 2014, 28(5):105-106.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛诊断和治疗建议[J].中华心血管病杂志, 2000, 28(6):409-412.
[4] Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Intervwntions Version 5.1.0.[updated Macch 2011][Z].The Cochrane Collaboration, 2011.
[5]井伟萌.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效分析[J].临床研究, 2015, 23(5):57-58.
[6]任爱华.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的效果[J].医学信息, 2016, 29(33):112-113.
[7]余君.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效分析[J].北方药学, 2018, 15(3):44-45.
[8]刘丽伟.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的疗效分析[J].大家健康(下旬版), 2016, 10(11):143.
[9]叶千琼.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛疗效分析[J].亚太传统医药, 2013, 9(6):161-163.
[10]吴延刚.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效分析[J].临床研究, 2017, 25(7):196, 198.
[11]周彦池,黄江,赵福兰,等.麝香保心丸、美托洛尔缓释片联合用药在冠心病不稳定型心绞痛治疗中的疗效与药理分析[J].医药前沿, 2018, 8(17):227-228.
[12]孙建,谭九根.美托洛尔联麝香保心丸治疗不稳定型心绞痛的疗效观察[J].医学信息, 2013,(25):447-448.
[13]张书军.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛的疗效分析[J].中国现代药物应用, 2015, 9(4):69-70.
[14]张伟萍.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定心绞痛临床疗效分析[J].中医临床研究, 2016, 8(6):42-43.
[15]张文政.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛临床观察[J].中国社区医师, 2014, 30(5):85, 87.
[16]张晓君,刘慧敏.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床分析[J].中外医疗, 2017, 36(25):24-26.
[17]徐美玲.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床疗效探讨[J].临床医药文献电子杂志, 2017, 4(41):8073.
[18]戚猛.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床观察[J].心理医生, 2015, 21(7):118-119.
[19]杨卫东.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定性心绞痛的效果观察[J].临床合理用药杂志, 2017, 10(11):3-4.
[20]杨吉操.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛疗效观察[J].临床研究, 2017, 25(9):162-163.
[21]林能波,李三英,石素珍.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床观察[J].中国现代药物应用,2013, 7(4):10-11.
[22]甘玉虎.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛的疗效分析[J].中国现代药物应用, 2016, 10(7):131-132.
[23]禹冬梅.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛效果探讨[J].世界最新医学信息文摘, 2017, 17(46):86-87.
[24]罗爱霞.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效评价[J].世界临床医学, 2016, 10(1):92.
[25]罗资洪.美托洛尔缓释片+麝香保心丸治疗冠心病不稳定型心绞痛的80例临床观察[J].中国保健营养, 2017, 27(34):351-352.
[26]肖扬.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛的疗效分析[J].中国实用医药, 2016, 11(9):165-166.
[27]芦桂萍,钱婀娜.麝香保心丸联合美托洛尔治疗不稳定性心绞痛的临床观察[J].中国现代药物应用, 2011, 5(16):68-69.
[28]荆珍,王晶.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床观察[J].首都食品与医药, 2017, 24(22):65-66.
[29]蔡蓉,敬超,向玉霞.不稳定型心绞痛应用美托洛尔辅以麝香保心丸的临床研究[J].中外医学研究, 2015, 13(19):137-138.
[30]赵德语.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定心绞痛临床观察[J].中国实用医药, 2010, 5(23):82-83.
[31]连亦田,朱晓阳.美托洛尔缓释片联合麝香保心丸治疗冠心病所致不稳定型心绞痛的效果观察[J].当代医药论丛, 2018, 16(11):181-182.
[32]陈洪春.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛临床效果观察[J].医药前沿, 2017, 7(4):202-203.
[33]雷红波.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定性心绞痛的效果分析[J].河南医学研究, 2018, 27(19):3551-3552.
[34]马雪梅.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛疗效分析[J].基层医学论坛, 2014, 18(17):2192-2193.
[35]魏苗苗.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定性心绞痛的临床效果[J].中西医结合心血管病电子杂志, 2017, 5(32):61-62.
[36]丁煜明,刘俊田.美托洛尔的药理特性及不良反应分析[J].临床合理用药杂志, 2018. 11(10):108-110.
[37]苏坤莲,凡永杰,刘原,等.冰片对心脑血管系统药理作用及其机制的研究进展[J].辽宁中医杂志, 2018, 45(9):2001-2003.
[38]林之云,蓝天,沈子悦,等.蟾酥的有效成分及药理作用概述[J].生物学教学, 2018, 43(1):4-5.
[39]梁晓艳,郭占京,罗佩卓,等.肉桂的药理作用研究概况[J].现代医药卫生, 2013, 29(10):1501-1503.
[40]赵丽晶.牛磺酸对缺血再灌注损伤心肌细胞的保护作用[D].长春:吉林大学, 2006.
[41]米娜瓦尔·买买提.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床疗效评价[J].世界最新医药信息文摘,2015, 15(20):100.
[42]朱雪晶,李海涛,喻斌,等.人工麝香对抗动物心肌缺血的作用[J].中国药理学通报, 2009, 25(7):951-954.
[2]谢辉.麝香保心丸联合西药治疗冠心病不稳定型心绞痛随机平行对照研究[J].实用中医内科杂志, 2014, 28(5):105-106.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛诊断和治疗建议[J].中华心血管病杂志, 2000, 28(6):409-412.
[4] Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Intervwntions Version 5.1.0.[updated Macch 2011][Z].The Cochrane Collaboration, 2011.
[5]井伟萌.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效分析[J].临床研究, 2015, 23(5):57-58.
[6]任爱华.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的效果[J].医学信息, 2016, 29(33):112-113.
[7]余君.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效分析[J].北方药学, 2018, 15(3):44-45.
[8]刘丽伟.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的疗效分析[J].大家健康(下旬版), 2016, 10(11):143.
[9]叶千琼.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛疗效分析[J].亚太传统医药, 2013, 9(6):161-163.
[10]吴延刚.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效分析[J].临床研究, 2017, 25(7):196, 198.
[11]周彦池,黄江,赵福兰,等.麝香保心丸、美托洛尔缓释片联合用药在冠心病不稳定型心绞痛治疗中的疗效与药理分析[J].医药前沿, 2018, 8(17):227-228.
[12]孙建,谭九根.美托洛尔联麝香保心丸治疗不稳定型心绞痛的疗效观察[J].医学信息, 2013,(25):447-448.
[13]张书军.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛的疗效分析[J].中国现代药物应用, 2015, 9(4):69-70.
[14]张伟萍.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定心绞痛临床疗效分析[J].中医临床研究, 2016, 8(6):42-43.
[15]张文政.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛临床观察[J].中国社区医师, 2014, 30(5):85, 87.
[16]张晓君,刘慧敏.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床分析[J].中外医疗, 2017, 36(25):24-26.
[17]徐美玲.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床疗效探讨[J].临床医药文献电子杂志, 2017, 4(41):8073.
[18]戚猛.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床观察[J].心理医生, 2015, 21(7):118-119.
[19]杨卫东.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定性心绞痛的效果观察[J].临床合理用药杂志, 2017, 10(11):3-4.
[20]杨吉操.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛疗效观察[J].临床研究, 2017, 25(9):162-163.
[21]林能波,李三英,石素珍.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床观察[J].中国现代药物应用,2013, 7(4):10-11.
[22]甘玉虎.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛的疗效分析[J].中国现代药物应用, 2016, 10(7):131-132.
[23]禹冬梅.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛效果探讨[J].世界最新医学信息文摘, 2017, 17(46):86-87.
[24]罗爱霞.美托洛尔缓释片联合麝香保心丸治疗不稳定心绞痛的疗效评价[J].世界临床医学, 2016, 10(1):92.
[25]罗资洪.美托洛尔缓释片+麝香保心丸治疗冠心病不稳定型心绞痛的80例临床观察[J].中国保健营养, 2017, 27(34):351-352.
[26]肖扬.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛的疗效分析[J].中国实用医药, 2016, 11(9):165-166.
[27]芦桂萍,钱婀娜.麝香保心丸联合美托洛尔治疗不稳定性心绞痛的临床观察[J].中国现代药物应用, 2011, 5(16):68-69.
[28]荆珍,王晶.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床观察[J].首都食品与医药, 2017, 24(22):65-66.
[29]蔡蓉,敬超,向玉霞.不稳定型心绞痛应用美托洛尔辅以麝香保心丸的临床研究[J].中外医学研究, 2015, 13(19):137-138.
[30]赵德语.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定心绞痛临床观察[J].中国实用医药, 2010, 5(23):82-83.
[31]连亦田,朱晓阳.美托洛尔缓释片联合麝香保心丸治疗冠心病所致不稳定型心绞痛的效果观察[J].当代医药论丛, 2018, 16(11):181-182.
[32]陈洪春.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛临床效果观察[J].医药前沿, 2017, 7(4):202-203.
[33]雷红波.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定性心绞痛的效果分析[J].河南医学研究, 2018, 27(19):3551-3552.
[34]马雪梅.美托洛尔缓释片联合麝香保心丸治疗不稳定型心绞痛疗效分析[J].基层医学论坛, 2014, 18(17):2192-2193.
[35]魏苗苗.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定性心绞痛的临床效果[J].中西医结合心血管病电子杂志, 2017, 5(32):61-62.
[36]丁煜明,刘俊田.美托洛尔的药理特性及不良反应分析[J].临床合理用药杂志, 2018. 11(10):108-110.
[37]苏坤莲,凡永杰,刘原,等.冰片对心脑血管系统药理作用及其机制的研究进展[J].辽宁中医杂志, 2018, 45(9):2001-2003.
[38]林之云,蓝天,沈子悦,等.蟾酥的有效成分及药理作用概述[J].生物学教学, 2018, 43(1):4-5.
[39]梁晓艳,郭占京,罗佩卓,等.肉桂的药理作用研究概况[J].现代医药卫生, 2013, 29(10):1501-1503.
[40]赵丽晶.牛磺酸对缺血再灌注损伤心肌细胞的保护作用[D].长春:吉林大学, 2006.
[41]米娜瓦尔·买买提.美托洛尔缓释片联合麝香保心丸治疗冠心病不稳定型心绞痛的临床疗效评价[J].世界最新医药信息文摘,2015, 15(20):100.
[42]朱雪晶,李海涛,喻斌,等.人工麝香对抗动物心肌缺血的作用[J].中国药理学通报, 2009, 25(7):951-954.