摘要
目的:系统评价通心络防治冠心病患者支架植入术后再狭窄效果。方法:检索关于通心络联合常规西药防治冠心病患者支架术后再狭窄的随机对照试验。使用NoteExpress 3.5.0软件根据纳排标准进行筛选,使用RevMan 5.3软件进行Meta分析。结果:共纳入文献16篇,样本量1 720例,其中治疗组863例,对照组857例。Meta分析结果显示:通心络联合常规西药在减少支架狭窄发生率(OR=0.27,95%CI[0.19,0.38],P<0.01),减少狭窄程度(MD=-10.42,95%CI[-13.92,-6.92],P<0.01),减少管腔丢失率(MD=-0.30,95%CI[-0.33,-0.27],P<0.01),增加管腔面积净获得率(MD=0.97,95%CI[0.76,1.18],P<0.01),减少心绞痛发生率(OR=0.22,95%CI[0.15,0.33],P<0.01),减少心肌梗死发生率(OR=0.25,95%CI[0.09,0.67],P<0.01),减少再住院率(OR=0.35,95%CI[0.14,0.86],P<0.05),减少再次PCI发生率(OR=0.16,95%CI[0.05,0.49],P<0.01),降低超敏C反应蛋白(MD=-0.90,95%CI[-1.23,-0.58],P<0.01),降低白细胞介素-6(MD=-1.66,95%CI[-1.95,-1.36],P<0.01),降低肿瘤坏死因-α(MD=-9.14,95%CI[-10.00,-8.27],P<0.01)等方面优于单纯西药组,且亚组分析显示,在降低超敏C反应蛋白方面,疗程越长,效果越好。结论:通心络联合常规西药在防治支架再狭窄、减少不良心血管事件、降低血清炎性因子方面疗效确切,值得临床推荐应用。
Objective:To evaluate the effect of Tongxinluo on prevention and treatment of restenosis after stent implantation in patients with coronary heart disease.Methods:The randomized controlled trials of Tongxinluo combined with conventional western medicine in the prevention and treatment of restenosis after stent implantation in patients with coronary heart disease were searched against 8 major academic journal databases including the China National Knowledge Infrastructure(CNKI) from inception to March 2021.NoteExpress 3.5.0 was used for article screening according to the inclusion and exclusion criteria,and RevMan 5.3 for meta-analysis.Results:A total of 16 articles were screened out,with a sample size of 1 720 cases,including 863 cases in the observation group and 857 cases in the control group.The results of meta-analysis showed that Tongxinluo combined with conventional western medicine could reduce the incidence of in-stent stenosis(OR=0.27,95%CI [0.19,0.38],P<0.01),the degree of stenosis(MD=-10.42,95%CI [-13.92,-6.92],P<0.01),and lumen loss(MD=-0.30,95%CI [-0.33,-0.27],P<0.01).In addition,this therapy could increase the net gain of lumen area(MD=0.97,95%CI [0.76,1.18],P<0.01) and reduce the incidence of angina pectoris(OR=0.22,95%CI [0.15,0.33],P<0.01),the incidence of myocardial infarction(OR=0.25,95%CI [0.09,0.67],P<0.01),the rate of re-hospitalization(OR=0.35,95%CI [0.14,0.86],P<0.05),and the incidence of re-percutaneous coronary intervention(OR=0.16,95%CI [0.05,0.49],P<0.01).Moreover,it could lower the serum levels of high-sensitivity C-reactive protein(MD=-0.90,95%CI [-1.23,-0.58],P<0.01),interleukin-6(MD=-1.66,95%CI [-1.95,-1.36],P<0.01),and tumor necrosis factor-α(MD=-9.14,95%CI [-10.00,-8.27],P<0.01).The effect of Tongxinluo combined with conventional western medicine was superior to that of western medicine alone.The subgroup analysis showed that the effect of reducing high-sensitivity C-reactive protein increased with the extension of the treatment course.Conclusion:Tongxinluo combined with conventional western medicine is effective in preventing and treating restenosis,reducing adverse cardiovascular events,and lowering serum levels of inflammatory cytokines,which is worthy of clinical recommendation.
作者
孙恒
邢作英
朱明军
陈召起
王永霞
SUN Heng;XING Zuoying;ZHU Mingjun;CHEN Zhaoqi;WANG Yongxia(Henan University of Chinese Medicine,Zhengzhou 450000;Department of Traditional Chinese Medicine,Henan Provincial People's Hospital,Zhengzhou 450000)
出处
《中药药理与临床》
CAS
CSCD
北大核心
2023年第6期88-93,共6页
Pharmacology and Clinics of Chinese Materia Medica
基金
国家重点研发计划“中医药现代化研究”重点专项(编号:2018YFC1707402)
国家重点研发计划课题(编号:2019YFC1710000)
国家中医药管理局中医药循证能力建设项目(编号:2019XZZX-XXG003)。
关键词
通心络
冠心病
支架狭窄
系统评价
META分析
Tongxinluo
Coronary heart disease
In-stent stenosis
Systematic review
Meta-analysis
作者简介
孙恒,硕士,研究方向:中医防治心血管疾病的研究,Email:sh13733166426@163.com;通信作者:王永霞,博士,主任医师,教授,博士研究生导师,研究方向:中西医结合防治心血管疾病的研究,E-mail:wyxchzhq@163.com。
