YANG Yan,HE Xiaofang,LIU Xiaoyun,et al.Systematic Review on Qili Qiangxin Capsules Combined with Conv entional Western Therapy in Treatment of Coronary Heart Disease with Chronic Heart Failure[J].zhongguo zhongyiyao xinxi zazhi,2021,28(2):39-45.[doi:10.19879/j.cnki.1005-5304.201911175]
芪苈强心胶囊辅助西医常规疗法治疗冠心病慢性心力衰竭系统评价
- Title:
- Systematic Review on Qili Qiangxin Capsules Combined with Conv entional Western Therapy in Treatment of Coronary Heart Disease with Chronic Heart Failure
- 文章编号:
- 1005-5304(2021)02-0039-07
- 分类号:
- R2-05；R259.416.1
- 文献标志码:
- A
- 摘要:
- 目的 系统评价芪苈强心胶囊辅助西医常规疗法治疗冠心病慢性心力衰竭的有效性及安全性。方法 通过检索中国知识资源总库（CNKI）、中国生物医学文献数据库（CBM）、中国学术期刊数据库（万方数据）、中文科技期刊数据库（维普网）、PubMed、Medline、EMBASE、Cochrane Library、ClinicalTrials.gov，收集芪苈强心胶囊治疗冠心病慢性心力衰竭随机对照试验（RCT）。采用Cochrane系统评价手册进行文献质量评价和数据提取，采用RevMan5.3对临床疗效指标进行Meta分析。结果 纳入文献17篇，涉及患者1570例。Meta分析结果显示：试验组总有效率高于对照组，差异有统计学意义（OR＝4.38，95%CI[3.22，5.94]，P＜0.000 01）；试验组较对照组可更好地改善患者左室射血分数、6 min步行距离、中医证候疗效，降低N端脑钠肽前体和血清脂联素水平，差异均有统计学意义（P＜0.05）。结论 芪苈强心胶囊辅助西医常规疗法治疗冠心病慢性心力衰竭疗效较好，临床安全性好，但纳入研究质量较低，有待更高质量的多中心、大样本RCT进行验证。
- Abstract:
- Objective To systematically review the efficacy and safety of Qili Qiangxin Capsules combined with conventional Western therapy in the treatment of chronic coronary heart failure. Methods The randomized controlled trials (RCTs) of Qili Qiangxin Capsules for treating coronary heart disease with chronic heart failure were collected by searching CNKI, CBM, PubMed, Wanfang Data , VIP, Medline, EMBASE, Cochrane Library, and ClinicalTrials.gov databases. The Cochrane Handbook for Systematic Reviews was used for literature quality evaluation and data extraction, and RevMan5.3 was used for meta-analysis on clinical efficacy indicators. Results Totally 17 articles were included, involving 1570 cases. Meta-analysis results showed that the total effective rate of the treatment group was higher than that in the control group, with statistical significance (OR=4.38, 95%CI [3.22, 5.94], P<0.000 01); compared with the control group, the treatment group significantly increased the left ventricular ejection fraction, six-minute walk distance, and efficacy of TCM syndromes, and significantly decreased NT-proBNP and APN levels of patients, with statistical significance ( P<0.05). Conclusion Qili Qiangxin Capsules is the effective approach to treat coronary heart disease with chronic heart failure, with higher clini cal safety. Because of the low quality of the included RCTs, more multi-centers and large-scale RCTs are needed for confirming this tendency.
参考文献/References:
[1] MENDEZ G F, COWIE M R. The epidemiological features of heart failure in developing countries：a review of the literature[J]. Int J Cardiol,2001,80(2/3)：213-219. [3] ALLA F, BRIANÇON S, JUILLIÈRE Y, et al. Differential clinical prognostic classifications in dilated and ischemic advanced heart failure：the EPICAL study[J]. Am Heart J,2000,139(5)：895-904. [4] ZHANG Y, ZHANG J, BUTLER J, et al. Contemporary epidemiology, management, and outcomes of patients hospitalized for heart failure in China：Results from the China Heart Failure (China-HF) Registry[J]. J Card Fail,2017,23(12)：868-875. [5] WONG M C, ZHANG D X, WANG H H. Rapid emergence of atherosclerosis in Asia：a systematic review of coronary atherosclerotic heart disease epidemiology and implications for prevention and control strategies[J]. Curr Opin Lipidol,2015,26(4)：257-269. [6] 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.慢性收缩性心力衰竭治疗建议[J].中华心血管病杂志,2002,30(1)：7-23. [7] 国家技术监督局.中国临床诊疗术语-疾病部分：GB/T 16751.1—1997[S].北京：中国标准出版社,1997：7-9. [8] 吴以岭.脉络论[M].北京：中国科学技术出版社,2010：781-786. [9] 翁维良.郭士魁临床经验选集：杂病证治[M].北京：人民卫生出版社, 2005：84-88. [10] 王亚红,王振涛.郭维琴教授对心力衰竭的中医认识与辨治[J].河南中医,2003,23(10)：12-13. [11] 解琳莉,赵勇,张为,等.从气、血、水关系探析心水之病机与治疗[J].中华中医药杂志,2012,27(8)：2113-2115. [12] 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.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2)：98-122. [13] 中国中西医结合学会心血管疾病专业委员会,中国医师协会中西医结合医师分会心血管病学专家委员会.慢性心力衰竭中西医结合诊疗专家共识[J].中西医结合心脑血管病杂志,2016,14(3)：225-232. [14] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京：中国医药科技出版社,2002：77-85. [15] 姚丹梅,刘争建.芪苈强心胶囊在冠心病慢性心力衰竭治疗中的应用价值[J].临床医学研究与实践,2017,2(12)：33-34. [16] 陈欣华,梁建英,孟文格,等.芪苈强心胶囊对缺血性心肌病心力衰竭患者左室重构、心功能、N-末端脑钠肽前体及肌钙蛋白Ⅰ的影响[J].疑难病杂志,2014,13(8)：831-834. [17] 段勇.曲美他嗪与芪苈强心胶囊联合使用治疗缺血性心肌病心力衰竭的疗效及安全性分析[J].家庭医药,2017(9)：81-82. [18] 高艳周,王宏斌,苗博,等.芪苈强心胶囊联合曲美他嗪治疗缺血性心肌病心力衰竭疗效观察[J].现代中西医结合杂志,2016,25(8)：845-847. [19] 陈雨,李海同,刘倩,等.左西孟旦联合芪苈强心胶囊对老年缺血性心肌病心力衰竭患者作用分析[J].河北医药,2018,40(15)：2256-2259. [20] 李帅,刘兵.芪苈强心胶囊对缺血性心肌病心力衰竭患者左心功能及血清炎性细胞因子的影响[J].中国医院用药评价与分析,2017,17(3)：366-368. [21] 陈小东,周峻.芪苈强心胶囊与曲美他嗪在缺血性心肌病心力衰竭患者中的联合应用[J].中国实验方剂学杂志,2015,21(19)：171-175. [22] 郭英丽.芪苈强心胶囊对冠脉粥样病变伴慢性左心衰患者血管内皮细胞功能及氧化应激的影响[J].西部中医药,2017,30(4)：85-87. [23] 赵小静.芪苈强心胶囊治疗冠心病慢性心力衰竭临床疗效观察[J].承德医学院学报,2017,34(3)：213-215. [24] 周建峰.中西医结合治疗冠心病慢性心衰的临床疗效分析[J].中国现代药物应用,2015,9(8)：146-147. [25] 王晓宁,沃金善,郭洁.芪苈强心胶囊辅助治疗冠心病合并左心舒张功能不全的临床效果[J].疑难病杂志,2016,15(2)：183-185,194. [26] 王强,韦斌,方显明,等.芪苈强心胶囊辅治冠心病及慢性心力衰竭疗效观察[J].中国社区医师,2012,28(19)：10. [27] 韩林林.芪苈强心胶囊对冠心病合并心衰患者相关血清因子水平及心功能影响研究[J].中国中医药现代远程教育,2018,16(3)：51-52. [28] 李强,郭壮波,黎庆梅,等.芪苈强心胶囊对冠心病合并心力衰竭患者血清脂联素水平及心功能的影响[J].中国病理生理杂志,2014,30(6)：1119-1122. [29] 王花.芪苈强心胶囊对冠心病合并心力衰竭患者血清脂联素水平及心功能的影响[J].现代中西医结合杂志,2017,26(22)：2450-2452. [30] 杨龙,王霞,彭威.芪苈强心胶囊对冠心病合并心力衰竭患者心功能的影响[J].现代中西医结合杂志,2017,26(15)：1658-1660. [31] 张萍.芪苈强心胶囊对CHF的LVEF和NT-BNP的影响[J].世界最新医学信息文摘,2015,15(26)：131-132. [32] DOKAINISH H, TEO K, ZHU J, et al. Global mortality variations in patients with heart failure：results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study[J]. Lancet Glob Health,2017,5(7)：e665-e672. [33] GILLMAN M W, KANNEL W B, BELANGER A, et al. Influence of heart rate on mortality among persons with hypertension：the Framingham Study[J]. Am Heart J,1993,125(4)：1148-1154. [34] 国家卫生计生委合理用药专家委员会,中国药师协会.冠心病合理用药指南(第2版)[J].中国医学前沿杂志(电子版),2018,10(6)：1-130. [35] BRISTOW M R. Beta-adrenergic receptor blockade in chronic heart failure[J]. Circulation,2000,101(5)：558-569. [36] 尚亚东,张家美,崔燕,等.芪苈强心胶囊治疗慢性心力衰竭的Meta分析[J].安徽医药,2013,17(11)：1949-1953. [37] 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.急性心力衰竭诊断和治疗指南[J].中华心血管病杂志,2010,38(3)：195-208. [38] TUTAREL O, DENECKE A, BODE-BÖGER S M, et al. Asymmetrical dimethylarginine - more sensitive than NT-proBNP to diagnose heart failure in adults with congenital heart disease[J]. PLoS One,2012,7(3)：e33795. [39] 邹筱冬,崔进,何芸.慢性心力衰竭患者血清脑钠肽、瘦素和脂联素水平变化及意义[J].山东医药,2016,56(17)：59-61. [40] 景宜馨,林湖滨,景雅.NT-proBNP在鉴别急性呼吸困难及评价心功能的临床应用[J].现代诊断与治疗,2015,26(9)：1928-1929,1996.
[2]World Health Organization. Cardiovascular disease：prevention and control[EB/OL].(2010-03-07)[2020-02-11].http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/.
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备注/Memo
基金项目：国家自然科学基金（81874445）
更新日期/Last Update:
2021-01-25