Wu Kerui, Deng Dingwei, Yu Binghui, Han Ziyun, Huang Lanlin, He Yaxing, Yan Xia, Wang Dawei
The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
Front Pharmacol. 2021 Apr 29;12:630896. doi: 10.3389/fphar.2021.630896. eCollection 2021.
Viral myocarditis (VMC) is a common emergency of cardiovascular disease. Current treatment for VMC includes the prohibition of exercise plus supportive and symptomatic treatment, given the lack of specific antiviral therapeutic options and insufficient evidence for the use of novel immunosuppressive therapies. Trimetazidine, a drug used to improve myocardial energy metabolism, is frequently used for the treatment of viral myocarditis. In China, Chinese herbal injections (CHIs) are often used in combination with trimetazidine. Therefore, we evaluate the efficacy and safety of CHI combined with trimetazidine in the treatment of VMC through the method of network meta-analysis. We searched PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Full-text Database (VIP), and China Biology Medicine Database (CBM) databases from inception to September 1, 2020, to identify eligible randomized controlled trials. The Cochrane risk of bias tool was used to assess the risk of bias among selected studies and the Stata 16.0 software was used to perform the network meta-analysis. A total of 29 studies were included, representing data from 2,687 patients. The effectiveness rate, level of myocardial injury marker, and the adverse reaction rate were evaluated. Compared with conventional treatment or conventional treatment combined with trimetazidine, CHIs combined with trimetazidine appeared to have a better therapeutic effect, with higher effectiveness rate and better reduction of the levels of creatine kinase, creatine kinase-MB, and lactate dehydrogenase. Based on surface under the cumulative ranking, Shenmai injection combined with trimetazidine appeared to be superior in terms of effective rate, while injection or and injection combined with trimetazidine appeared most effective in reducing myocardial injury markers. There was no significant difference in safety between the interventions. However, a lack of safety monitoring in some selected studies meant that the safety of some interventions could not be fully evaluated. CHIs combined with trimetazidine may have therapeutic value in the treatment of viral myocarditis, and Shenmai injection, injection, and and injection may represent the most effective CHIs. Further clinical investigation is required to confirm these results.
病毒性心肌炎（VMC）是心血管疾病中常见的急症。鉴于缺乏特异性抗病毒治疗选择且使用新型免疫抑制疗法的证据不足，目前VMC的治疗包括禁止运动以及支持性和对症治疗。曲美他嗪是一种用于改善心肌能量代谢的药物，常用于治疗病毒性心肌炎。在中国，中药注射剂（CHIs）常与曲美他嗪联合使用。因此，我们通过网状Meta分析方法评估CHIs联合曲美他嗪治疗VMC的疗效和安全性。我们检索了PubMed、Cochrane图书馆、Embase、中国知网（CNKI）、万方数据库、维普中文科技期刊全文数据库（VIP）和中国生物医学文献数据库（CBM），检索时间从建库至2020年9月1日，以确定符合条件的随机对照试验。采用Cochrane偏倚风险工具评估所选研究中的偏倚风险，并使用Stata 16.0软件进行网状Meta分析。共纳入29项研究，代表2687例患者的数据。评估了有效率、心肌损伤标志物水平和不良反应发生率。与传统治疗或传统治疗联合曲美他嗪相比，CHIs联合曲美他嗪似乎具有更好的治疗效果，有效率更高，肌酸激酶、肌酸激酶同工酶MB和乳酸脱氢酶水平降低更明显。基于累积排序曲线下面积，参麦注射液联合曲美他嗪在有效率方面似乎更优，而[具体注射液名称1]注射液或[具体注射液名称2]注射液以及[具体注射液名称3]注射液联合曲美他嗪在降低心肌损伤标志物方面似乎最有效。各干预措施在安全性方面无显著差异。然而，一些所选研究中缺乏安全性监测，这意味着某些干预措施的安全性无法得到充分评估。CHIs联合曲美他嗪可能对病毒性心肌炎的治疗具有治疗价值，参麦注射液、[具体注射液名称1]注射液以及[具体注射液名称2]注射液和[具体注射液名称3]注射液可能是最有效的CHIs。需要进一步的临床研究来证实这些结果。
