中医药治疗急性心肌梗死后心室重构疗效的Meta分析
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摘要
目的:评价中医药联合西药常规治疗急性心肌梗死(AMI)后心室重构的疗效及安全性。方法:选取并检索中国知网、万方数据库、维普网、Pub Med、Cochrane图书馆各建库日期至2018年8月,比较中医药联合西药常规治疗与单纯西药常规治疗AMI后心室重构的临床随机对照试验,按照Cochrane评价纳入文献质量,采用Revman5. 3软件进行Meta分析,再用Grade Pro软件对主要结局指标进行证据等级评价。结果:共纳入17项研究,共计1 501例患者。Meta分析显示联合治疗可减少左室舒张末容积(SMD=-0. 37[-0. 63,-0. 12]),减小左室质量指数(SMD=-0. 41[-0. 76,-0. 07]),升高左室射血分数(SMD=0. 79[0. 58,1. 00]),且治疗有效率高于单纯常规治疗(OR=4. 56[2. 27,9. 17])。结论:中药能安全有效地减轻AMI后患者心室重构的程度。
Objective: To evaluate the efficacy and safety of traditional Chinese medicine (TCM) combined with western medicine in the treatment of ventricular remodeling after acute myocardial infarction (AMI). Methods: The literatures of Chinese National Knowledge Infrastructure (CNKI),Wanfang Journal Database,Pub Med,and Cochrane Library from date of their establishment to August 2018 were searched for the randomized controlled trials of compared TCM combined with western medicine and western medicine alone for ventricular remodeling after AMI. The quality of the literature included was evaluated according to the Cochrane,and the Revman 5. 3 software was used to perform the Meta-analysis,and Grade Pro software to evaluate the evidence level of the main outcome indicators. Results: A total of 17 studies were included,accounted for a total of 1501 patients. Meta-analysis showed that combination therapy reduced left ventricular end-diastolic volume (SMD =-0. 37[-0. 63,-0. 12]),decreased left ventricular mass index (SMD =-0. 41[-0. 76,-0. 07]),increased left ventricular ejection fraction (SMD = 0. 79[0. 58,1. 00]).Treatment efficiency was higher than conventional treatment (OR = 4. 56[2. 27,9. 17]). Conclusion: TCM can safely and effectively reduce the degree of ventricular remodeling in patients after AMI.
Objective: To evaluate the efficacy and safety of traditional Chinese medicine (TCM) combined with western medicine in the treatment of ventricular remodeling after acute myocardial infarction (AMI). Methods: The literatures of Chinese National Knowledge Infrastructure (CNKI),Wanfang Journal Database,Pub Med,and Cochrane Library from date of their establishment to August 2018 were searched for the randomized controlled trials of compared TCM combined with western medicine and western medicine alone for ventricular remodeling after AMI. The quality of the literature included was evaluated according to the Cochrane,and the Revman 5. 3 software was used to perform the Meta-analysis,and Grade Pro software to evaluate the evidence level of the main outcome indicators. Results: A total of 17 studies were included,accounted for a total of 1501 patients. Meta-analysis showed that combination therapy reduced left ventricular end-diastolic volume (SMD =-0. 37[-0. 63,-0. 12]),decreased left ventricular mass index (SMD =-0. 41[-0. 76,-0. 07]),increased left ventricular ejection fraction (SMD = 0. 79[0. 58,1. 00]).Treatment efficiency was higher than conventional treatment (OR = 4. 56[2. 27,9. 17]). Conclusion: TCM can safely and effectively reduce the degree of ventricular remodeling in patients after AMI.
引文
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[18]吴东南,范世平,王世承,等.加味补阳还五汤对心肌梗死后慢性心力衰竭患者Lp-PLA2、hs-CRP及NT-proBNP的影响[J].现代中医临床,2017,24(3):16-19.
[19]王磊.芪参益气滴丸治疗急性心肌梗死90例疗效观察[J].实用医技杂志,2014,21(2):186-187.
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[21]胡占军,徐良,王利清,等.参松养心胶囊对急性心肌梗死后临床疗效分析[J].解放军预防医学杂志,2016,(S2):204-205.
[22]Kirkpatrick JN,St JSM.Assessment of ventricular remodeling in heart failure clinical trials[J].Curr Heart Fail Rep,2012,9(4):328-336.
[23]朱开权.瑞舒伐他汀钙片对大鼠心肌梗死后炎症反应及NF-kB的影响[J].中西医结合心血管病(连续型电子期刊),2016,4(27):2-3.
[24]魏传中.阿托伐他汀用于急性心肌梗死后左心室重构防治中的临床效果[J].心血管病防治知识,2017,16(2):31-32.
[25]张兆国.益气活血解毒方干预急性心肌梗死大鼠心室重构的研究[D].北京:北京中医药大学,2017.
[26]方红义.芪苈强心减轻小鼠心肌梗死后心肌重构机制的研究[D].南京:南京医科大学,2015.
[2]Spinelli L,Morisco C,Assante dPE,et al.Reverse left ventricular remodeling after acute myocardial infarction:the prognostic impact of left ventricular global torsion[J].Int J Cardiovasc Imaging,2013,29(4):787-795.
[3]Reddy S,Bernstein D.Molecular Mechanisms of Right Ventricular Failure[J].Circulation,2015,132(18):1734-1742.
[4]国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:233-237.
[5]常风云,董银平.护心方治疗急性心肌梗死33例[J].中国实验方剂学杂志,2013,19(13):323-326.
[6]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.
[7]金彦彦,高海,聂绍平,等.参附注射液对急性ST段抬高型心肌梗死并发心源性休克患者炎性因子水平的影响[J].中国医药,2016,11(4):489-493.
[8]李少春,马丽娜,陈坚,等.大蒜辣素对大鼠心肌梗死后纤维化的影响及与TGFβ/Smads信号通路的关系[J].中国中药杂志,2016,41(13):2517-2521.
[9]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.
[10]邓绍林,林惠京,钟春媚.温阳补气汤改善急性心肌梗死病人左心室功能的研究[J].中西医结合心脑血管病杂志,2007,5(1):3-4.
[11]贾平,訾海燕,曾玉杰.参附注射液对急性下壁ST段抬高型心肌梗死合并低血压患者经皮冠状动脉介入术后疗效和血管内皮细胞功能的影响[J].中国医药,2016,11(6):789-792.
[12]张学正.惠心胶囊干预急性心肌梗死早期溶栓再通后心室重构的临床研究[D].济南:山东中医药大学,2008.
[13]张林.益心通治疗AMI后左室重构的临床研究[J].山东医药,2006,46(34):47-48.
[14]刘泉颖.通冠胶囊对急性心肌梗死患者介入术后心功能及生活质量影响的研究[D].广州:广州中医药大学,2010.
[15]钱晨.补阳还五汤加减对急性心梗PCI术后气虚血瘀型患者心室重构的影响[D].南京:南京中医药大学,2016.
[16]许书嘉.清热活血法联合益气养阴法对AMI患者PCI术后心功能的影响及随访研究[D].广州:广州中医药大学,2016.
[17]樊艳艳.参枣养心汤对PCI后气虚血瘀型AMI患者左室重构的观察[D].广州:广州中医药大学,2014.
[18]吴东南,范世平,王世承,等.加味补阳还五汤对心肌梗死后慢性心力衰竭患者Lp-PLA2、hs-CRP及NT-proBNP的影响[J].现代中医临床,2017,24(3):16-19.
[19]王磊.芪参益气滴丸治疗急性心肌梗死90例疗效观察[J].实用医技杂志,2014,21(2):186-187.
[20]范远.心梗救逆汤对急性心肌梗死患者心室重构及心功能的影响[J].河南医学研究,2018,27(12):2230-2231.
[21]胡占军,徐良,王利清,等.参松养心胶囊对急性心肌梗死后临床疗效分析[J].解放军预防医学杂志,2016,(S2):204-205.
[22]Kirkpatrick JN,St JSM.Assessment of ventricular remodeling in heart failure clinical trials[J].Curr Heart Fail Rep,2012,9(4):328-336.
[23]朱开权.瑞舒伐他汀钙片对大鼠心肌梗死后炎症反应及NF-kB的影响[J].中西医结合心血管病(连续型电子期刊),2016,4(27):2-3.
[24]魏传中.阿托伐他汀用于急性心肌梗死后左心室重构防治中的临床效果[J].心血管病防治知识,2017,16(2):31-32.
[25]张兆国.益气活血解毒方干预急性心肌梗死大鼠心室重构的研究[D].北京:北京中医药大学,2017.
[26]方红义.芪苈强心减轻小鼠心肌梗死后心肌重构机制的研究[D].南京:南京医科大学,2015.