活血化瘀法中药复方治疗慢性阻塞性肺疾病合并肺动脉高压疗效及安全性的Meta分析被引量：6

Meta-Analysis of Efficacy and Safety of TCM Compound of Promoting Blood Circulation and Removing Stasis in Treatment of Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Arterial Hypertension

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摘要目的系统评价活血化瘀法中药复方治疗慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)合并肺动脉高压(Pulmonary hypertension,PH)的有效性及安全性。方法计算机检索CNKI、Wanfang Data、VIP Database、CBM、PubMed、Web of science、Embase、Cochrane Library中英文数据库自建库至2023年4月30日期间,活血化瘀法治疗COPD合并PH的随机对照试验,并提取数据,采用Revman 5.3软件进行Meta分析与系统评价,其安全性指标用不良反应发生率来评价。结果共纳入文献42篇,涉及患者3558例,实验组活血化瘀法联合西医常规治疗组1794例,对照组西医常规治疗组1764例。Meta分析结果显示:与对照组比较,实验组提高临床有效率[RR=1.26,95%CI(1.21,1.31),P<0.0001];改善患者缺氧、二氧化碳潴留:血氧分压(Arterial partial pressure of oxygen,PaO_(2))[SMD=0.92,95%CI(0.60,1.24),P<0.0001]、二氧化碳分压(Arterial partial pressure of carbon dioxide,PaCO_(2))[SMD=-0.97,95%CI(-1.41,-0.52),P<0.0001]、动脉血氧饱和度(Arterial oxygen saturation,SaO_(2))[MD=2.36,95%CI(0.92,3.80),P=0.001];降低肺循环压力:肺动脉收缩压(Pulmonary artery systolic pressure,PASP)[MD=-4.55,95%CI(-5.60,-3.51),P<0.0001];改善临床症状,提高运动耐量:6 min步行距离(6-minute walking distance,6MWD)[MD=51.00,95%CI(39.80,62.19),P<0.0001]、证候总评分[MD=-2.91,95%CI(-3.52,-2.31),P<0.0001]、改良英国医学研究委员会呼吸困难量表(Modified British medical research council dyspnea scores,mMRC)评分[MD=-0.82,95%CI(-0.89,-0.76),P<0.0001]和慢阻肺患者自我评估测试(COPD assessment test,CAT)问卷[MD=-6.49,95%CI(-12.74,-0.25),P=0.04];提高血清一氧化氮(Nitric oxide,NO)[SMD=0.83,95%CI(0.35,1.32),P=0.0007]等方面有优势;但在不良反应发生率方面无显著差异[RR=1.50,95%CI(0.44,5.11),P=0.52]。结论活血化瘀法中药复方联合西医常规治疗COPD合并PH具有较好的临床疗效,能显著提高临床有效率、改善患者缺氧、二氧化碳潴留,改善临床症状,提高运动耐量,降低肺循环压力等。但在安全性方面尚待进一步研究,未来仍需更多严谨高质量RCT研究来验证。 Objective To systematically evaluate the efficacy and safety of traditional Chinese medicine(TCM)compound of promoting blood circulation and removing stasis in the treatment of chronic obstructive pulmonary disease(COPD)complicated with pulmonary arterial hypertension(PH).Methods CNKI,Wanfang Data,VIP Database,CBM,PubMed,Web of Science,Embase,and Cochrane Library Chinese and English databases were searched by computer from their establishment to April 30,2023.The randomized controlled trials(RCTs)about TCM compound of promoting blood circulation and removing stasis in the treatment of COPD complicated with PH were searched,and data were extracted.Meta-analysis and systematic review were performed using Revman 5.3 software.The safety index was evaluated by the incidence of adverse reactions.Results A total of 42 pieces of literature were included,involving 3558 patients,including 1794 patients in the experimental group receiving TCM compound of promoting blood circulation and removing stasis and conventional western medicine treatment and 1764 patients in the control group receiving conventional western medicine treatment.The Meta-analysis results showed that compared with the control group,the experimental group enhanced clinical efficacy[RR=1.26,95%CI(1.21,1.31),P<0.0001]and improved patients'hypoxia and carbon dioxide retention:arterial partial pressure of oxygen(PaO_(2))[SMD=0.92,95%CI(0.60,1.24),P<0.0001],arterial partial pressure of carbon dioxide(PaCO_(2))[SMD=-0.97,95%CI(-1.41,-0.52),P<0.0001],and arterial oxygen saturation(SaO_(2))[MD=2.36,95%CI(0.92,3.80),P=0.001].Pulmonary circulation pressure:pulmonary artery systolic pressure(PASP)[MD=-4.55,95%CI(-5.60,-3.51),P<0.0001]was decreased.Clinical symptoms and exercise tolerance:6-minute walking distance(6MWD)[MD=51.00,95%CI(39.80,62.19),P<0.0001],total syndrome score[MD=-2.91,95%CI(-3.52,-2.31),P<0.0001],modified British medical research council dyspnea scores(mMRC)[MD=-0.82,95%CI(-0.89,-0.76),P<0.0001],and COPD patient assessment test(CAT)questionnaire[MD=-6.49,95%CI(-12.74,-0.25),P=0.04]were improved.It had advantages in improving serum nitric oxide(NO)[SMD=0.83,95%CI(0.35,1.32),P=0.0007]and other aspects.However,there was no significant statistical difference in the incidence of adverse reactions[RR=1.50,95%CI(0.44,5.11),P=0.52].Conclusion TCM compound of promoting blood circulation and removing stasis combined with conventional western medicine has good clinical efficacy in the treatment of COPD complicated with PH.It can significantly improve clinical effective rate,hypoxia,carbon dioxide retention,clinical symptoms of patients,and exercise tolerance and reduce pulmonary circulation pressure.However,further studies on its safety are needed,and more high-quality RCTs are required for verification in the future.

作者刘影刘嘉敏马艺钊李亚张海龙 LIU Ying;LIU Jia-min;MA Yi-zhao;LI Ya;ZHANG Hai-long(Henan University of Chinese Medicine,Henan Zhengzhou 450046;The First Affiliated Hospital of Henan University of Chinese Medicine,Henan Zhengzhou 450003)

机构地区河南中医药大学河南中医药大学第一附属医院

出处《世界中西医结合杂志》 2024年第6期1074-1086,共13页 World Journal of Integrated Traditional and Western Medicine

基金国家中医药管理局中医药科学技术研究专项(GZY-KJS-2021-016) 河南省中医药科学研究专项课题(2019JDZX2004) 河南省特色骨干学科中医学学科建设项目(STG-ZYX02-202108)。

关键词中药活血化瘀慢性阻塞性肺疾病肺动脉高压 META分析 Traditional Chinese Medicine Promoting Blood Circulation and Removing Stasis Chronic Obstructive Pulmonary Disease Pulmonary Arterial Hypertension Meta-Analysis

分类号 R563 [医药卫生—呼吸系统]

作者简介通信作者:张海龙,Email:zhanghailong6@126.com。