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丹红注射液联合经皮冠状动脉介入治疗急性冠状动脉综合征的疗效:一项系统评价与Meta分析

The Therapeutic Efficacy of Danhong Injection Combined With Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

作者信息

Zou Jun-Bo, Zhang Xiao-Fei, Wang Jing, Wang Fang, Cheng Jiang-Xue, Yang Fang-Yan, Song Xiao, Wang Yu, Liang Yu-Lin, Shi Ya-Jun

机构信息

College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China.

Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.

出版信息

Front Pharmacol. 2018 Jun 4;9:550. doi: 10.3389/fphar.2018.00550. eCollection 2018.

Abstract

Percutaneous coronary intervention (PCI) is widely used in treatment of acute coronary syndrome (ACS) clinically. It is believed that Danhong injection (DHI) extracted from and combined with PCI could increase the therapeutic efficacy on ACS. We provide an updated meta-analysis with detailed information on combination of DHI and PCI therapy. Electronic databases were searched for appropriate articles without language limitations on key words before October 22, 2017. All trails were screened according to certain criteria. Quality of eligible studies was also assessed. We made a detailed record of outcome measurements. RevMan 5.3 software was used to perform the meta-analysis. 14 articles involving 1533 patients with ACS were selected. Compared to PCI treatment alone, total efficacy rate (TER) was enhanced and major adverse cardiovascular events (MACE) were reduced significantly for the combination of DHI and PCI ( < 0.00001). Vascular endothelial function was improved by significantly decreasing the contents of ET-1, vWF and increasing the levels of NO and FMD ( < 0.00001). The serum levels of IL-1, IL-6, IL-18, TNF-α, LpPLA2, MMP-9, and pentraxin-3 were significantly decreased ( < 0.00001), whereas IL-10 in serum was increased ( < 0.00001), indicating a stronger anti-inflammatory effect of the combination. The combination therapy decreased the serum levels of CD62P, PAGT, PADT, FIB-C significantly ( < 0.05), which was beneficial for preventing coagulation of platelets. Blood lipid was also affected by regulating TC, TG, LDL, and HDL, but the results were not statistically significant ( > 0.05). Cardiac function was improved by increasing LEVF ( = 0.006) but not LVED ( = 0.08). The combination treatment was associated with an improvement in antioxidant effect by decreasing MDA and increasing SOD significantly ( < 0.00001). Combination of DHI and PCI in treatment of ACS could improve TER and reduce incidence of MACE after PCI therapy. These effects may be mediated by combined actions of several mechanisms. However, these results of this study should be handled cautiously due to the limitations of this research. Several rigorous RCTs are in need to confirm these findings.

摘要

经皮冠状动脉介入治疗(PCI)在临床上广泛应用于急性冠状动脉综合征(ACS)的治疗。据信,从[具体药材名1]和[具体药材名2]中提取的丹红注射液(DHI)联合PCI可提高对ACS的治疗效果。我们提供了一项更新的荟萃分析,详细介绍了DHI与PCI治疗联合应用的情况。在2017年10月22日前,通过电子数据库检索了关于关键词的合适文章,无语言限制。所有试验均根据特定标准进行筛选。还评估了符合条件的研究的质量。我们对结局测量进行了详细记录。使用RevMan 5.3软件进行荟萃分析。选择了14篇涉及1533例ACS患者的文章。与单纯PCI治疗相比,DHI与PCI联合应用的总有效率(TER)提高,主要不良心血管事件(MACE)显著减少(P<0.00001)。通过显著降低内皮素-1(ET-1)、血管性血友病因子(vWF)含量并提高一氧化氮(NO)和血流介导的血管舒张(FMD)水平,血管内皮功能得到改善(P<0.00001)。血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、脂蛋白相关磷脂酶A2(LpPLA2)、基质金属蛋白酶-9(MMP-9)和五聚素-3水平显著降低(P<0.00001),而血清中白细胞介素-10增加(P<0.00001),表明联合应用具有更强的抗炎作用。联合治疗显著降低了血清CD62P、血小板聚集率(PAGT)、血小板黏附率(PADT)、纤维蛋白原(FIB-C)水平(P<0.05),这有利于预防血小板凝集。血脂也受到总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)和高密度脂蛋白(HDL)调节的影响,但结果无统计学意义(P>0.05)。通过增加左心室射血分数(LEVF,P=0.006)改善了心功能,但左心室舒张末期内径(LVED,P=0.08)未改善。联合治疗通过显著降低丙二醛(MDA)并增加超氧化物歧化酶(SOD),抗氧化作用得到改善(P<0.00001)。DHI与PCI联合治疗ACS可提高TER并降低PCI治疗后MACE的发生率。这些作用可能由多种机制的联合作用介导。然而,由于本研究的局限性,本研究的这些结果应谨慎对待。需要几项严格的随机对照试验来证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea37/5994407/55347cded88d/fphar-09-00550-g001.jpg

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