中西医结合治疗痰浊型冠心病疗效的系统评价与Meta分析
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摘要
目的用循证医学的方法评价中药联合西医常规治疗痰浊型冠心病的疗效。方法检索2007年1月至2017年4月英文数据库(Cochrane Library、Medline)及中文数据库(万方数据、VIP、CNKI、CBM)。根据纳入及排除标准,有19项临床试验,1679例痰浊型冠心病患者(治疗组874例,对照组805例)纳入本研究。使用RevMan 5.2软件合并分析纳入研究患者的中医证候疗效有效率、心电图疗效有效率、心绞痛症状疗效有效率、每周心绞痛发作次数、每次心绞痛持续时间、血脂水平、左室射血分数变化、硝酸甘油停减率等结局指标。结果在提高中医证候疗效、心电图疗效、心绞痛症状疗效、左室射血分数,降低患者总胆固醇(TC)水平、每周心绞痛发作次数,缩短每次心绞痛发作持续时间方面,治疗组优于对照组。在考察的其他方面,两组作用相当。结论中西医结合较单用西医常规治疗痰浊型冠心病在某些方面可能具有优势,但还需进一步开展高质量的临床试验加以证实。
Objective To evaluate the efficacy on coronary heart disease of turbid phlegm type treated with Chinese herbal medicine and western medicine,using the method of the evidence-based medicine. Methods The literatures were retrieved from the database of English version(Cochrane Library and Medline) and Chinese version(Wanfang,VIP,CNKI and CBM) from January 2007 to April 2017. According to the inclusive and exclusive criteria,19 clinical trials were included in the study,with 1679 patients of coronary heart disease of turbid phlegm type(874 cases in the treatment group and 805 cases in the control group. Rev Man 5. 2 software combined analysis was adopted to study the outcomes,such as the effective rate of TCM syndrome,the effective rate of ECG,the effective rate for angina pectoris,the attack frequency of angina pectoris each week,the duration of each attack,blood lipid level,the changes of LVEF and the discontinuity rate and reducing rate of nitroglycerin. Results Regarding the improvements in the efficacies of TCM syndrome,ECG and the symptoms of angina pectoris,as well as LVEF score and reducing TC level,the attack frequency of angina pectoris each week,and shortening the duration of each attack,the results in the treatment group were better than the control group. As for the other aspects,the effects were similar between the two groups. Conclusion The integrated Chinese and western medicine achieves the potential advantages in the treatment of coronary heart disease of turbid phlegm type as compared with the routine western medicine. But,the high-quality clinical trial is required to have a further verification.
Objective To evaluate the efficacy on coronary heart disease of turbid phlegm type treated with Chinese herbal medicine and western medicine,using the method of the evidence-based medicine. Methods The literatures were retrieved from the database of English version(Cochrane Library and Medline) and Chinese version(Wanfang,VIP,CNKI and CBM) from January 2007 to April 2017. According to the inclusive and exclusive criteria,19 clinical trials were included in the study,with 1679 patients of coronary heart disease of turbid phlegm type(874 cases in the treatment group and 805 cases in the control group. Rev Man 5. 2 software combined analysis was adopted to study the outcomes,such as the effective rate of TCM syndrome,the effective rate of ECG,the effective rate for angina pectoris,the attack frequency of angina pectoris each week,the duration of each attack,blood lipid level,the changes of LVEF and the discontinuity rate and reducing rate of nitroglycerin. Results Regarding the improvements in the efficacies of TCM syndrome,ECG and the symptoms of angina pectoris,as well as LVEF score and reducing TC level,the attack frequency of angina pectoris each week,and shortening the duration of each attack,the results in the treatment group were better than the control group. As for the other aspects,the effects were similar between the two groups. Conclusion The integrated Chinese and western medicine achieves the potential advantages in the treatment of coronary heart disease of turbid phlegm type as compared with the routine western medicine. But,the high-quality clinical trial is required to have a further verification.
引文
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[10]李莉.瓜蒌薤白半夏汤加味治疗冠心病稳定型心绞痛(痰浊内阻型)的临床研究[J].世界最新医学信息文摘,2015,102(15):148-149.
[11]陈仁山,肖惠珍,刘宁,等.祛痰泄浊法调节冠心病(痰浊证)患者颈动脉硬化的临床研究[J].中国中医急症,2013,22(8):1293-1294.
[12]代娜,曲辑.加味瓜蒌薤白半夏汤对痰浊壅塞型冠心病患者血脂及血浆同型半胱氨酸的影响[J].中外医疗,2014,34(36):159-160.
[13]毛桃桃,徐瑛.调中降浊方治疗痰阻心脉型冠心病稳定型心绞痛的临床观察[J].四川中医,2013,31(6):100-102.
[14]伊文刚.导痰汤化裁治疗痰浊阻络型冠心病心绞痛71例[J].中医研究,2012,25(12):28-30.
[15]薛宁,李颖,黄桢,等.胸痹3号方治疗痰阻心脉型冠心病PC I术后心绞痛疗效观察[J].中西医结合心脑血管病杂志,2014,12(11):1293-1295.
[16]王世红,谢吟灵.怡安汤加减辅助治疗痰浊中阻型胸痹心痛68例[J].中成药,2010,32(5):889-890.
[17]甘桃梅.加味栝楼薤白半夏汤对痰浊内阻证冠心病心绞痛患者心肌酶学及血脂的影响[J].西藏医药,2015,36(3):82-84.
[18]焦春发,张跃军,董进宇.苦碟子注射液治疗痰阻心脉型冠心病心绞痛的临床效果观察[J].转化医学电子杂志,2015,2(2):37-38.
[19]李颖,董耀荣,黄桢,等.胸痹3号方对痰阻心脉型心绞痛患者纤维蛋白原及D-二聚体的影响[J].辽宁中医杂志,2015,42(4):697-699.
[20]蔡茂玉.枳实薤白桂枝汤联合西药治疗痰阻气滞冠心病心绞痛随机平行对照研究[J].实用中医内科杂志,2016,30(8):63-65.
[21]谭琦.舒心汤治疗冠心病不稳定型心绞痛痰阻心脉证的疗效观察[J].中医临床研究,2016,8(33):2-4.
[22]王家良.临床流行病学:临床科研设计、测量与评价[M].上海:上海科学技术出版社,2009:158.
[23]Schulz KF,Altman DG,Moher D.CONSORT 2010 Statement:updated guidelines for reporting parallel group randomised trials[J].BMC Med,2010,8(1):18.
[24]Kong D,Wang Y,Liu Y,et al.The association between blood lipid and phlegm turbidity syndrome of angina pectoris:a systematic review and meta-analysis[J].Complementary Therapies in Medicine,2014,22(4):801-813.
[2]中华人民共和国卫生部.中药新药研究指导原则[M].北京:中国医药科出版社,2002:6-73.
[3]卢宪伟,顾颖敏.观察温胆汤加味对痰浊型冠心病患者的相关危险因子的作用[J].中医临床研究,2015,7(25):1-4.
[4]赵东凯,曹亚丽.豁痰通阳汤治疗冠心病心绞痛(痰浊内阻型)56例临床观察[J].中国疗养医学,2015,24(7):727-728.
[5]王海涛,宋国庆,姜颖韶.经方泽泻汤加味治疗胸痹痰浊壅塞证临床观察[J].辽宁中医药大学学报,2009,11(1):89-90.
[6]杨帆.瓜蒌薤白半夏汤合涤痰汤加减治疗痰浊闭阻型胸痹心痛临床观察[J].陕西中医,2017,38(2):178-179.
[7]曲争艳,孟庆峰,王建明,等.芩连香砂六君子汤治疗痰浊中阻型慢性心力衰竭30例临床观察[J].长春中医药大学学报,2012,28(6):1057-1058.
[8]高萍.瓜蒌薤白半夏汤合温胆汤治疗不稳定性心绞痛痰浊壅塞证40例疗效观察[J].四川中医,2007,25(12):70-71.
[9]单自琴,许剑婕.瓜蒌薤白半夏汤加减治疗冠心病心绞痛痰浊痹阻证对于心肌血运重建的影响[J].世界中医药,2017,12(1):53-60.
[10]李莉.瓜蒌薤白半夏汤加味治疗冠心病稳定型心绞痛(痰浊内阻型)的临床研究[J].世界最新医学信息文摘,2015,102(15):148-149.
[11]陈仁山,肖惠珍,刘宁,等.祛痰泄浊法调节冠心病(痰浊证)患者颈动脉硬化的临床研究[J].中国中医急症,2013,22(8):1293-1294.
[12]代娜,曲辑.加味瓜蒌薤白半夏汤对痰浊壅塞型冠心病患者血脂及血浆同型半胱氨酸的影响[J].中外医疗,2014,34(36):159-160.
[13]毛桃桃,徐瑛.调中降浊方治疗痰阻心脉型冠心病稳定型心绞痛的临床观察[J].四川中医,2013,31(6):100-102.
[14]伊文刚.导痰汤化裁治疗痰浊阻络型冠心病心绞痛71例[J].中医研究,2012,25(12):28-30.
[15]薛宁,李颖,黄桢,等.胸痹3号方治疗痰阻心脉型冠心病PC I术后心绞痛疗效观察[J].中西医结合心脑血管病杂志,2014,12(11):1293-1295.
[16]王世红,谢吟灵.怡安汤加减辅助治疗痰浊中阻型胸痹心痛68例[J].中成药,2010,32(5):889-890.
[17]甘桃梅.加味栝楼薤白半夏汤对痰浊内阻证冠心病心绞痛患者心肌酶学及血脂的影响[J].西藏医药,2015,36(3):82-84.
[18]焦春发,张跃军,董进宇.苦碟子注射液治疗痰阻心脉型冠心病心绞痛的临床效果观察[J].转化医学电子杂志,2015,2(2):37-38.
[19]李颖,董耀荣,黄桢,等.胸痹3号方对痰阻心脉型心绞痛患者纤维蛋白原及D-二聚体的影响[J].辽宁中医杂志,2015,42(4):697-699.
[20]蔡茂玉.枳实薤白桂枝汤联合西药治疗痰阻气滞冠心病心绞痛随机平行对照研究[J].实用中医内科杂志,2016,30(8):63-65.
[21]谭琦.舒心汤治疗冠心病不稳定型心绞痛痰阻心脉证的疗效观察[J].中医临床研究,2016,8(33):2-4.
[22]王家良.临床流行病学:临床科研设计、测量与评价[M].上海:上海科学技术出版社,2009:158.
[23]Schulz KF,Altman DG,Moher D.CONSORT 2010 Statement:updated guidelines for reporting parallel group randomised trials[J].BMC Med,2010,8(1):18.
[24]Kong D,Wang Y,Liu Y,et al.The association between blood lipid and phlegm turbidity syndrome of angina pectoris:a systematic review and meta-analysis[J].Complementary Therapies in Medicine,2014,22(4):801-813.