Huang Jianchun, Tang Xiaojun, Ye Fangxing, He Junhui, Kong Xiaolong
Pharmaceutical College, Guangxi Medical University, Nanning, China.
Cell Physiol Biochem. 2016;39(5):1955-1963. doi: 10.1159/000447892. Epub 2016 Oct 24.
BACKGROUND/AIMS: Coronary heart disease is characterized by vascular stenosis or occlusion resulting in myocardial ischemia, hypoxia and necrosis. In China, the combination of aspirin and Fufang Danshen Diwan (FDD), a traditional Chinese medicine formula, has been suggested in the treatment of coronary heart disease. There have been several studies comparing the effectiveness of aspirin alone and in combination with FDD to treat coronary artery disease; however, it remains unclear whether combined aspirin therapy is superior. This study was thus designed to clarify this issue through a systematic review and meta-analysis. METHODS: Databases including PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) database, Wanfang Data and VIP Information were searched. Papers were reviewed systematically by two researchers and analyzed using Cochrane software Revman 5.1. RESULTS: Fourteen randomized controlled trials enrolling 1367 subjects were included. Meta-analyses revealed that aspirin in combination with FDD was significantly more effective at alleviating angina pectoris and improving electrocardiogram (ECG) results relative to aspirin therapy alone, reflected by the summary effects for the clinical markedly effective (OR = 2.45; 95% CI 1.95-3.08) and the total effective (OR = 3.92; 95% CI 2.87-5.36) rates. In addition, combined aspirin and FDD was significantly more efficacious than aspirin monotherapy at improving blood lipid levels, as indicated by the following outcomes: 1) reduction of TC level (SMD -1.12; 95% CI -1.49 to -0.76); 2) reduction of TG level (SMD -0.94; 95% CI -1.15 to -0.74); 3) reduction of LDL level (SMD -0.68; 95% CI -0.88 to -0.48); and 4) improvement of HDL level (SMD 0.52; 95% CI 0.04 to 0.99 ). No serious adverse events were reported in any of the included trials. CONCLUSION: The present meta-analysis demonstrated that aspirin in combination with FDD was more effective than aspirin alone for treating coronary heart disease. More full-scale randomized clinical trials with reliable designs are recommended to further evaluate the clinical benefits and long-term effectiveness of FDD for the treatment of coronary heart disease.
背景/目的：冠心病的特征是血管狭窄或闭塞，导致心肌缺血、缺氧和坏死。在中国，阿司匹林与中药复方丹参滴丸（FDD）联合使用被推荐用于治疗冠心病。已有多项研究比较了单独使用阿司匹林以及阿司匹林与FDD联合使用治疗冠状动脉疾病的有效性；然而，联合使用阿司匹林治疗是否更具优势仍不明确。因此，本研究旨在通过系统评价和荟萃分析来阐明这一问题。 方法：检索包括PubMed、EMBASE、中国知网数据库、万方数据和维普资讯在内的数据库。由两名研究人员对论文进行系统评价，并使用Cochrane软件Revman 5.1进行分析。 结果：纳入了14项随机对照试验，共1367名受试者。荟萃分析显示，与单独使用阿司匹林治疗相比，阿司匹林联合FDD在缓解心绞痛和改善心电图结果方面显著更有效，这体现在临床显效（OR = 2.45；95%CI 1.95 - 3.08）和总有效率（OR = 3.92；95%CI 2.87 - 5.36）的汇总效应上。此外，阿司匹林联合FDD在改善血脂水平方面比单药治疗显著更有效，具体表现为以下结果：1）总胆固醇（TC）水平降低（标准化均数差[SMD] -1.12；95%CI -1.49至-0.76）；2）甘油三酯（TG）水平降低（SMD -0.94；95%CI -1.15至-0.74）；3）低密度脂蛋白（LDL）水平降低（SMD -0.68；95%CI -0.88至-0.48）；4）高密度脂蛋白（HDL）水平升高（SMD 0.52；95%CI 0.04至0.99）。纳入的任何试验均未报告严重不良事件。 结论：本荟萃分析表明，阿司匹林联合FDD治疗冠心病比单独使用阿司匹林更有效。建议开展更多设计可靠的大规模随机临床试验，以进一步评估FDD治疗冠心病的临床益处和长期有效性。
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