瓜蒌薤白半夏汤加减方治疗冠心病心绞痛的系统评价
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摘要
目的系统评价瓜蒌薤白半夏汤加减方(GXBD)治疗冠心病心绞痛的有效性与安全性。方法计算机检索CNKI、Wanfang Data、CBM、PubMed数据库,检索相关随机对照试验,收集关于GXBD治疗冠心病心绞痛的临床随机对照试验,筛选文献,提取数据和评价纳入研究质量,使用软件RevMan 5.3进行Meta分析。结果共纳入20项随机对照试验,共计1 810例病人。Meta分析结果显示,试验组GXBD联合常规西药的心绞痛疗效优于对照组常规西药,差异有统计学意义[OR=2.83,95%CI (2.22,3.61),P <0.000 01],根据干预对象的不同进行亚组分析,试验组治疗不稳定型心绞痛病人与稳定型心绞痛病人的心绞痛疗效均高于对照组[OR=4.47,95%CI(2.16,9.27),P <0.000 1;OR=2.48,95%CI(1.22,5.04),P=0.01],试验组心电图疗效和中医证候疗效高于对照组[OR=3.86,95%CI(2.95,5.05),P <0.000 01;OR=4.68,95%CI(2.34,9.39),P <0.000 1]。结论 GXBD可有效改善冠心病心绞痛病人的心绞痛、心电图和中医症候疗效,且安全性较好。但限于纳入研究的文献质量总体一般,上述结论有待更多高质量随机对照试验加以证实。
Objective To systematically evaluate the efficacy and safety of Gualou Xiebai Banxia Decoction(GXBD)in treatment of angina pectoris.Methods The relevant randomized trials(RCTs)were retrieved from China National Knowledge Infrastructure(CNKI),Wanfang database,CBM,Pubmed.After screening the literature,extracting the data and evaluating the methodological quality of the included studies,meta-analysis was performed using the software RevMan 5.3.Results Twenty RCTs with 1 810 patients were enrolled.Meta-analysis showed that the efficacy of GXBD and conventional western medicine in the experimental group was better than that in the control group[OR=2.83,95%CI(2.22,3.61),P < 0.000 01].The subgroup analyses showed that compared with western routine treatment group,the efficacy of the experimental group in patients with unstable angina and stable angina pectoris were better than that of the control group[OR=4.47,95%CI(2.16,9.27 P <0.000 1;OR=2.48,95%CI(1.22,5.04),P =0.01)].The electrocardiogram efficacy and TCM syndrome efficacy of the experimental group were higher than those of the control group[OR=3.86,95% CI(2.95,5.05),P <0.000 01;OR=4.68,95% CI(2.34,9.39),P < 0.000 1].Conclusion Existing evidences suggest that GXBD is effective in the treatment of angina pectoris due to coronary heart disease,and can improve angina pectoris,electrocardiogram,and the syndrome of traditional Chinese medicine.Due to low quality of included literatures,more RCTs with high quality are still needed for further verification.
Objective To systematically evaluate the efficacy and safety of Gualou Xiebai Banxia Decoction(GXBD)in treatment of angina pectoris.Methods The relevant randomized trials(RCTs)were retrieved from China National Knowledge Infrastructure(CNKI),Wanfang database,CBM,Pubmed.After screening the literature,extracting the data and evaluating the methodological quality of the included studies,meta-analysis was performed using the software RevMan 5.3.Results Twenty RCTs with 1 810 patients were enrolled.Meta-analysis showed that the efficacy of GXBD and conventional western medicine in the experimental group was better than that in the control group[OR=2.83,95%CI(2.22,3.61),P < 0.000 01].The subgroup analyses showed that compared with western routine treatment group,the efficacy of the experimental group in patients with unstable angina and stable angina pectoris were better than that of the control group[OR=4.47,95%CI(2.16,9.27 P <0.000 1;OR=2.48,95%CI(1.22,5.04),P =0.01)].The electrocardiogram efficacy and TCM syndrome efficacy of the experimental group were higher than those of the control group[OR=3.86,95% CI(2.95,5.05),P <0.000 01;OR=4.68,95% CI(2.34,9.39),P < 0.000 1].Conclusion Existing evidences suggest that GXBD is effective in the treatment of angina pectoris due to coronary heart disease,and can improve angina pectoris,electrocardiogram,and the syndrome of traditional Chinese medicine.Due to low quality of included literatures,more RCTs with high quality are still needed for further verification.
引文
[1]柴光德.中医药治疗冠心病心绞痛的研究进展[J].世界临床药物,2016,37(6):432-436.
[2]李孟魁,宋俊生,郭利平.《金匮要略》方治疗冠心病方剂运用规律研究[J].辽宁中医杂志,2016,43(5):949-953.
[3]国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组缺血性心脏病的命名及诊断标准[J].中华心血管病杂志,1981,9(1):75-76.
[4]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.慢性稳定性心绞痛诊断与治疗指南[J].中华心血管病杂志,2007,35(3):195-206.
[5]陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2008:211-213.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:68-69.
[7]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:29-31.
[8]全国中西医结合防治及心律失常研究座谈会.冠心病心绞痛及心电图疗效标准[J].中医杂志,1996,37(10):583.
[9]郭静,张科伟.中医中药治疗冠心病并血脂异常的临床观察[J].光明中医,2016,31(11):1588-1589.
[10]杨建昆.瓜蒌薤白半夏汤联合西药治疗冠心病心绞痛随机平行对照研究[J].实用中医内科杂志,2015,29(12):107-109.
[11]张海文.瓜蒌薤白半夏汤加味治疗冠心病心绞痛痰瘀互结型42例[J].光明中医,2015,30(11):2439-2441.
[12]曾望远.活血化痰生脉汤治疗冠心病心绞痛临床观察[J].四川中医,2014,32(10):115-117.
[13]许继艳,常秀武,丁瑞峰,等.中西医结合治疗60例冠心病心绞痛的疗效观察[J].中国生化药物杂志,2014,34(3):111-113.
[14]臧威.瓜蒌薤白半夏汤合二陈汤加味方治疗冠心病心绞痛痰浊闭阻证的临床研究[D].济南:山东中医药大学,2014.
[15]史培锋,王亢,李巧兰,等.瓜蒌薤白半夏汤化裁配合西药治疗冠心病心绞痛45例疗效观察[J].现代中医药,2013,33(6):11-12.
[16]王长建,马秀明,王竹风,等.瓜蒌薤白半夏汤合血府逐瘀汤加减治疗痰瘀互结型胸痹心痛32例临床观察[J].新中医,2013,45(8):12-14.
[17]赵雁翎.加味瓜蒌薤白半夏汤对痰浊心脉型SAP炎症因子的影响[D].广州:广州中医药大学,2013.
[18]李明海,杨铭.瓜蒌薤白半夏汤加味治疗不稳定型心绞痛的临床观察[J].中国中医药咨讯,2012,4(1):152.
[19]蔡少杭,陈晖,吴瑞华,等.胸痹片对冠心病不稳定型心绞痛病人血浆肾素-血管紧张素浓度的影响[J].齐齐哈尔医学院学报,2012,33(9):1135-1136.
[20]黄霞.加味瓜蒌薤白半夏汤治疗胸痹心痛40例[J].河南中医,2012,32(10):1283-1284.
[21]唐建.四合汤治疗冠心病心绞痛40例[J].湖南中医杂志,2012,28(4):28-29.
[22]徐满春,张建清,龙慧玲,等.中西医结合治疗冠心病不稳定性心绞痛40例临床观察[J].中医药导报,2011,17(5):111-113.
[23]陈正瑜.温胆汤合瓜蒌薤白半夏汤加减治疗冠心病不稳定型心绞痛的临床观察[J].广州:广州中医药大学,2011.
[24]吕予,路亚娥,侯杰军,等.瓜蒌薤白半夏汤合丹参饮治疗痰瘀互阻型胸痹38例[J].陕西中医,2011,32(10):1289-1290.
[25]聂长勇.中西医结合治疗冠心病稳定型心绞痛68例临床观察[J].北京中医药,2011,30(8):609-611.
[26]唐世球.中西医结合治疗冠心病稳定性心绞痛46例疗效观察[J].甘肃中医学院学报,2011,28(1):33-34.
[27]江宏革.栝蒌薤白半夏汤联合血府逐瘀汤治疗心绞痛合并高脂血症临床疗效观察[J].中国医药导报,2010,7(21):81-82.
[28]柳杨彬,乔晓林.瓜蒌薤白半夏汤合温胆汤辅助治疗胸痹心痛50例体会[J].西部中医药,2007,20(10):37-38.
[29]李航,李建锋,赵启韬.瓜蒌薤白半夏汤的心肌保护机制研究进展[J].中医药导报,2014,20(15):39-41.
[2]李孟魁,宋俊生,郭利平.《金匮要略》方治疗冠心病方剂运用规律研究[J].辽宁中医杂志,2016,43(5):949-953.
[3]国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组缺血性心脏病的命名及诊断标准[J].中华心血管病杂志,1981,9(1):75-76.
[4]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.慢性稳定性心绞痛诊断与治疗指南[J].中华心血管病杂志,2007,35(3):195-206.
[5]陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2008:211-213.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:68-69.
[7]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:29-31.
[8]全国中西医结合防治及心律失常研究座谈会.冠心病心绞痛及心电图疗效标准[J].中医杂志,1996,37(10):583.
[9]郭静,张科伟.中医中药治疗冠心病并血脂异常的临床观察[J].光明中医,2016,31(11):1588-1589.
[10]杨建昆.瓜蒌薤白半夏汤联合西药治疗冠心病心绞痛随机平行对照研究[J].实用中医内科杂志,2015,29(12):107-109.
[11]张海文.瓜蒌薤白半夏汤加味治疗冠心病心绞痛痰瘀互结型42例[J].光明中医,2015,30(11):2439-2441.
[12]曾望远.活血化痰生脉汤治疗冠心病心绞痛临床观察[J].四川中医,2014,32(10):115-117.
[13]许继艳,常秀武,丁瑞峰,等.中西医结合治疗60例冠心病心绞痛的疗效观察[J].中国生化药物杂志,2014,34(3):111-113.
[14]臧威.瓜蒌薤白半夏汤合二陈汤加味方治疗冠心病心绞痛痰浊闭阻证的临床研究[D].济南:山东中医药大学,2014.
[15]史培锋,王亢,李巧兰,等.瓜蒌薤白半夏汤化裁配合西药治疗冠心病心绞痛45例疗效观察[J].现代中医药,2013,33(6):11-12.
[16]王长建,马秀明,王竹风,等.瓜蒌薤白半夏汤合血府逐瘀汤加减治疗痰瘀互结型胸痹心痛32例临床观察[J].新中医,2013,45(8):12-14.
[17]赵雁翎.加味瓜蒌薤白半夏汤对痰浊心脉型SAP炎症因子的影响[D].广州:广州中医药大学,2013.
[18]李明海,杨铭.瓜蒌薤白半夏汤加味治疗不稳定型心绞痛的临床观察[J].中国中医药咨讯,2012,4(1):152.
[19]蔡少杭,陈晖,吴瑞华,等.胸痹片对冠心病不稳定型心绞痛病人血浆肾素-血管紧张素浓度的影响[J].齐齐哈尔医学院学报,2012,33(9):1135-1136.
[20]黄霞.加味瓜蒌薤白半夏汤治疗胸痹心痛40例[J].河南中医,2012,32(10):1283-1284.
[21]唐建.四合汤治疗冠心病心绞痛40例[J].湖南中医杂志,2012,28(4):28-29.
[22]徐满春,张建清,龙慧玲,等.中西医结合治疗冠心病不稳定性心绞痛40例临床观察[J].中医药导报,2011,17(5):111-113.
[23]陈正瑜.温胆汤合瓜蒌薤白半夏汤加减治疗冠心病不稳定型心绞痛的临床观察[J].广州:广州中医药大学,2011.
[24]吕予,路亚娥,侯杰军,等.瓜蒌薤白半夏汤合丹参饮治疗痰瘀互阻型胸痹38例[J].陕西中医,2011,32(10):1289-1290.
[25]聂长勇.中西医结合治疗冠心病稳定型心绞痛68例临床观察[J].北京中医药,2011,30(8):609-611.
[26]唐世球.中西医结合治疗冠心病稳定性心绞痛46例疗效观察[J].甘肃中医学院学报,2011,28(1):33-34.
[27]江宏革.栝蒌薤白半夏汤联合血府逐瘀汤治疗心绞痛合并高脂血症临床疗效观察[J].中国医药导报,2010,7(21):81-82.
[28]柳杨彬,乔晓林.瓜蒌薤白半夏汤合温胆汤辅助治疗胸痹心痛50例体会[J].西部中医药,2007,20(10):37-38.
[29]李航,李建锋,赵启韬.瓜蒌薤白半夏汤的心肌保护机制研究进展[J].中医药导报,2014,20(15):39-41.