文献类型：期刊文献

中文题名：不同中药注射液联合常规西药治疗急性心力衰竭的网状Meta分析

英文题名：Network Meta-analysis of different Chinese medicine injections combined with conventional western medicine in treatment of acute heart failure

作者：王薇[1];孔繁婷[1];李蕊[1];赵信科[2];李应东[1,2];刘凯[1]

第一作者：王薇

机构：[1]甘肃中医药大学,甘肃兰州730000;[2]甘肃中医药大学附属医院,甘肃兰州730000

第一机构：甘肃中医药大学

年份：2024

卷号：49

期号：1

起止页码：251

中文期刊名：中国中药杂志

外文期刊名：China Journal of Chinese Materia Medica

收录：CSTPCD;;Scopus;北大核心:【北大核心2023】；CSCD:【CSCD2023_2024】；PubMed;

基金：国家自然科学基金项目(82260869);甘肃省中医药防治重大疾病科研课题(GZKZD-2018-2)。

语种：中文

中文关键词：急性心力衰竭;中药注射液;网状Meta分析;临床疗效

外文关键词：acute heart failure;Chinese medicine injection;network Meta-analysis;clinical effect

摘要：系统评价中药注射液治疗急性心力衰竭的疗效及安全性。计算机检索PubMed、Cochrane Library、EMbase、Web of Science、中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)数据库,搜集中药注射液联合常规西药治疗急性心力衰竭的随机对照试验(RCT),检索时限均为建库至2023年7月10日,由2名研究者独立筛选文献、提取资料、评价纳入研究的偏倚风险后,采用Stata 15.1软件进行网状Meta分析。共纳入117篇RCTs,包括10 529例患者,7种中药注射液:参附注射液、参麦注射液、丹红注射液、葛根素注射液、心脉隆注射液、生脉注射液、益气复脉注射液。网状Meta分析显示:(1)提高总有效率方面,累计概率排名曲线下面积(SUCRA)排序为生脉注射液+常规西药>丹红注射液+常规西药>参麦注射液+常规西药>参附注射液+常规西>心脉隆注射液+常规西药>益气复脉注射液+常规西药>葛根素注射液+常规西药>常规西药;(2)降低脑钠肽(BNP)方面,SUCRA排序为丹红注射液+常规西药>心脉隆注射液+常规西药>益气复脉注射液+常规西药>参附注射液+常规西药>参麦注射液+常规西药>葛根素注射液+常规西药>生脉注射液+常规西药>常规西药;(3)降低N末端B型利钠肽前体(NT-proBNP)方面,SUCRA排序为参麦注射液+常规西药>益气复脉注射液+常规西药>心脉隆注射液+常规西药>生脉注射液+常规西药>参附注射液>葛根素注射液+常规西药>丹红注射液+常规西药>常规西药;(4)提高左心室射血分数(LVEF)方面,SUCRA排序为参麦注射液+常规西药>心脉隆注射液+常规西药>参附注射液+常规西药>益气复脉注射液+常规西药>葛根素注射液+常规西药>丹红注射液+常规西药>生脉注射液+常规西药>常规西药;(5)降低左心室舒张末期内径(LVEDD)方面,SUCRA排序为参麦注射液+常规西药>参附注射液+常规西药=心脉隆注射液+常规西药>生脉注射液+常规西药>益气复脉注射液+常规西药>常规西药>葛根素注射液+常规西药;(6)提高6 min步行试验(6MWT)方面,SUCRA排序为心脉隆注射液+常规西药>参附注射液+常规西药>参麦注射液+常规西药>益气复脉注射液+常规西药>常规西药;(7)降低明尼苏达州心功能不全生活质量量表(MLHFQ)评分方面,SUCRA排序为心脉隆注射液+常规西药>参麦注射液+常规西药>参附注射液+常规西药>常规西药;(8)安全性方面,中药注射液联合常规西药的不良反应整体少于常规西药。当前证据表明,在常规西药治疗的基础上联合中药注射液可提高急性心力衰竭的治疗效果,且安全性更好。受纳入研究数量和质量的限制,上述结论待更多高质量研究予以验证。
This study aims to evaluate the efficacy and safety of Chinese medicine injection in the treatment of acute heart failure. PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang, and SinoMed were searched for the randomized controlled trial(RCT) of Chinese medicine injection combined with conventional western medicines in the treatment of acute heart failure with the time interval from the inception to July 10, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata 15.1 was used to perform network Meta-analysis. A total of 117 RCTs were included, involving 10 529 patients and 7 Chinese medicine injections: Shenfu Injection, Shenmai Injection, Danhong Injection, Puera-rin Injection, Xinmailong Injection, Shengmai Injection, and Yiqi Fumai Injection. Network Meta-analysis yielded the following results.(1) In terms of improving the total response rate, the surface under the cumulative ranking curve(SUCRA) ranking was Shengmai Injection + conventional western medicine > Danhong Injection + conventional western medicine > Shenmai Injection + conventio-nal western medicine > Shenfu Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Puerarin Injection + conventional western medicine > conventional western medicine.(2)In terms of reducing brain natriuretic peptide(BNP), the SUCRA ranking was Danhong Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Puerarin Injection + conventional wes-tern medicine > Shengmai Injection + conventional western medicine > conventional western medicine.(3)In terms of reducing N-terminal pro-brain natriuretic peptide(NT-proBNP), the SUCRA ranking was Shenmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Puerarin Injection + conventional western medicine > Danhong Injection + conventional western medicine > conventional western medicine.(4) In terms of improving the left ventricular ejection fraction(LVEF), the SUCRA ranking was Shenmai Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Puerarin Injection + conventional western medicine > Danhong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > conventional western medicine.(5) In terms of decreasing the left ventricular end-diastolic diameter(LVEDD), the SUCRA ranking was Shenmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine=Xinmailong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > conventional western medicine > Puerarin Injection + conventional western medicine.(6) In terms of increasing the 6-min walk trail(6MWT), the SUCRA ranking was Xinmailong Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > conventional western medicine.(7) In terms of reducing the Minnesota heart failure quality of life scale(MLHFQ) scores, the SUCRA ranking was Xinmailong Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > conventional western medicine.(8)In terms of safety, the group of Chinese medicine injection combined with conventional western medicine had lower incidence of adverse reactions than the control group. The current evidence shows that combining Chinese medicine injection with conventional western medicine treatment can improve the therapeutic effect on acute heart failure, with high safety. Due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.