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Archive > Volume 16 Issue 4 > 2024,16(4):622-637. DOI:https://doi.org/10.1016/j.chmed.2023.12.005 Prev Next

復(fù)方丹參滴丸聯(lián)合單硝酸異山梨酯治療心絞痛療效的系統(tǒng)評價和Meta分析

Original articles

Compound Danshen Dripping Pills combined with isosorbide mononitrate for angina pectoris: A systematic review and a Meta-analysis

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    摘要:
    目的：系統(tǒng)評價復(fù)方丹參滴丸 (CDDP) 聯(lián)合單硝酸異山梨酯 (ISMN) 與單獨使用ISMN治療心絞痛的療效。方法:通過計算機檢索PubMed、Web of Science、Cochrane Library、Embase、CNKI、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫、萬方醫(yī)學(xué)網(wǎng)等中關(guān)于CDDP聯(lián)合ISMN治療心絞痛的隨機對照試驗和隊列研究，檢索時間為建庫至2022年11月。進一步篩選出符合的文獻并提取數(shù)據(jù)進行Meta分析。數(shù)據(jù)采用Stata 14軟件和Spss 26進行分析。結(jié)果:最終納入59項隨機對照試驗和11項隊列研究，共7081例心絞痛患者。Meta分析結(jié)果顯示:CDDP聯(lián)合ISMN治療心絞痛的心絞痛癥狀聯(lián)合心電圖療效(OR = 4.824, 95% CI = 3.636?6.401, P = 0.000)、心絞痛癥狀療效(OR = 4.347, 95% CI = 3.635?5.198, P = 0.000)和心電圖療效(OR = 3.364, 95% CI = 2.767?4.089, P = 0.000)均優(yōu)于單獨使用ISMN；同時，聯(lián)合用藥在降低總膽固醇(MD = ?24.296, 95% CI = ?26.429 to ?22.163, P = 0.000)和甘油三酯 (MD = ?35.176, 95% CI = ?37.439 to ?32.912, P = 0.000)、縮短心絞痛發(fā)作時間(MD = ?1.991, 95% CI = ?2.349 to ?1.633, P = 0.000)，減少心絞痛發(fā)作頻率(SMD = ?2.840, 95% CI = ?3.416 to ?2.265, P = 0.000)方面也優(yōu)于單獨使用ISMN；CDDP聯(lián)合ISMN與單獨使用ISMN組不良反應(yīng)發(fā)生率無顯著性差異(OR = 0.513, 95% CI = 0.421?0.626, P = 0.000)。結(jié)論：CDDP聯(lián)合ISMN治療心絞痛優(yōu)于單用ISMN，患者耐受性良好。這種中西醫(yī)結(jié)合的療法可以作為患者的另一種治療選擇。但納入文獻普遍質(zhì)量不高，且存在一定的發(fā)表偏倚，期待進一步的證據(jù)驗證。

    Abstract:
    Objective: To evaluate the efficacy of Compound Danshen Dripping Pills (CDDP) combined with isosorbide mononitrate (ISMN) versus ISMN alone for treating angina pectoris in patients. Methods: The PubMed, Web of Science, Cochrane Library, Embase China National Knowledge Infrastructure, China Biomedical Literature Service System, Chinese Medical Journal Database, and Wan Fang MED databases were searched from inception to November 2022. Randomized controlled trials (RCTs) and cohort studies were included. The primary outcomes were angina symptom and electrocardiography (ECG) efficacy, angina symptom efficacy, and ECG efficacy. The protocol was registered with PROSPERO No. CRD42022314774. Results: Our study included 7 245 patients with angina (59 RCTs, 11 cohort studies). When ISMN was combined with CDDP, the efficacy of angina symptom and ECG [odds ratio (OR) = 4.824, 95% confidence interval (CI) = 3.636–6.401, P = 0.000], the efficacy of angina symptom (OR = 4.347, 95% CI = 3.635–5.198, P = 0.000), the efficacy of ECG (OR = 3.364, 95% CI = 2.767–4.089, P = 0.000) were better than that of patients treated with ISMN alone. CDDP combined with ISMN was superior to ISMN alone in reducing triglyceride (TG) [mean difference (MD) =–35.176, 95% CI = –37.439 to–32.912, P = 0.000], total cholesterol (TC) (MD = –24.296, 95% CI =–26.429 to –22.163, P = 0.000), the duration of angina attack (MD =–1.991, 95% CI =–2.349 to–1.633, P = 0.000), and the frequency of angina attack [standardized MD (SMD) = –2.840, 95% CI =–3.416 to–2.265, P = 0.000]. There was no increase in adverse events between CDDP combined with ISMN and ISMN alone (OR = 0.513, 95% CI = 0.421–0.626, P = 0.000). Conclusion: CDDP combined with ISMN improved treatment efficacy and was well tolerated. Therefore, this combination could be used as an alternative treatment. However, clinical and patient conditions should be considered.

    關(guān)鍵詞:
    心絞痛;復(fù)方丹參滴丸;單硝酸異山梨酯;Meta分析;系統(tǒng)評價

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