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阿司匹林联合复方丹参滴丸对中老年冠心病患者血液流变学及血脂的影响:系统评价和荟萃分析。

The Effects of Aspirin With Combined Compound Danshen Dropping Pills on Hemorheology and Blood Lipids in Middle-Aged and Elderly Patients With CHD: A Systematic Review and Meta-Analysis.

机构信息

State Key Laboratory of Precision Measuring Technology and Instruments, Tianjin University, Tianjin, China.

Tianjin University of Traditional Chinese Medicine, Tianjin, China.

出版信息

Front Public Health. 2021 Jun 18;9:664841. doi: 10.3389/fpubh.2021.664841. eCollection 2021.


DOI:10.3389/fpubh.2021.664841
PMID:34222174
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8249928/
Abstract

Coronary heart disease (CHD) is one of the most common diseases in clinical cardiovascular practice, mainly afflicting the middle-aged and elderly. It will greatly affect elderly quality of life, and even affect their psychological and physical health. At present, CHD is treated with western drugs alone, but this can produce drug dependency. In recent years, Traditional Chinese Medicine (TCM) combine western drugs has been used as a complementary and alternative therapy, and its effectiveness and safety have been proven, attracting the attention of numerous researchers. Our study aimed to compare the efficacy of Aspirin with Combined Compound Danshen Dropping Pills had a superior effect on the treatment of Hemorheology and Blood Lipids in Middle-aged and Elderly Patients with CHD. Determine the effectiveness and safety of Aspirin with Combined Compound Danshen Dropping Pills in the treatment of CHD, and obtain high quality clinical evidence. Based on the PRISMA Statement, inclusion and exclusion criteria were formulated. Randomized controlled trials (RCTs) on the Effects of Aspirin with Combined Compound Danshen Dropping Pills on Hemorheology and Blood Lipids in Middle-aged and Elderly Patients with CHD were found following a search of 4 mainstream medical databases. RCTs found to meet the study's requirement were included; data information was then extracted, and the quality assessed using the Cochrane bias risk assessment tool. Through RevMan software, Meta analysis was carried out for overall TC, TG, HDL-C, LDL-C hematocrit, high shear viscosity, low shear viscosity, plasma viscosity, PAGM, and TXB effective rate. The relative risk (RR) and 95% confidence interval (95% ) were calculated; heterogeneity was tested and its source found; publication bias was assessed through the Egger and Begg tests, and by means of funnel plots. 22 RCTs were found, involving 1,987 cases. The results of the Meta analysis showed that, compared to drug therapy alone, Aspirin with Combined Compound Danshen Dropping Pills had a superior effect on the treatment of Hemorheology and Blood Lipids in Middle-aged and Elderly Patients with CHD. The meta analysis results show the effects on TC [MD = -0.91, 95% CI (-1.09, -0.73)], on TG [MD = -0.94, 95% CI (-1.22, -0.66)], on HDL-C [MD = 0.40, 95% CI (0.27, 0.53)], on LDL-C [MD = -0.99, 95% CI (-1.24, -0.74)], on hematocrit [MD = -2.69, 95% CI (-3.73, -1.65)], on high shear blood viscosity [MD = -1.11, 95% CI (-2.18, -0.05)], on low shear viscosity [MD = -0.79, 95% CI (-0.89, -0.68)], on plasma viscosity [MD = -0.26, 95% CI (-0.52, 0.01)], on PAMG [MD = -10.75, 95% CI (-16.84, -4.67)], and on TXB [MD = -11.84, 95% CI (-14.75, -8.92)]. The source of heterogeneity might be related to the state of patient, efficacy of drugs in the control group and difference in judgment criteria for efficacy. The Egger test and Begg test showed that publication bias did not occur in our study. The combination of compound dropping pill DSP with aspirin has some therapeutic effect on blood lipids and hemorheology in patients with CHD, ince some of the RCTs featured a very small sample size, the reliability and validity of our study's conclusion may have been affected as well; therefore, the explanation should be treated with some caution. In the future, a large number of higher-quality RCTs are still needed to confirm the results of our study.

摘要

冠心病(CHD)是临床心血管实践中最常见的疾病之一,主要影响中老年人。它会极大地影响老年人的生活质量,甚至影响他们的心理和身体健康。目前,CHD 仅用西药治疗,但这会产生药物依赖性。近年来,中药(TCM)与西药结合已被用作一种补充和替代疗法,其疗效和安全性已得到证实,引起了众多研究人员的关注。

我们的研究旨在比较阿司匹林与复方丹参滴丸联合使用对中老年冠心病患者血液流变学和血脂的治疗效果。确定阿司匹林与复方丹参滴丸联合使用治疗冠心病的疗效和安全性,获得高质量的临床证据。

基于 PRISMA 声明,制定了纳入和排除标准。通过搜索 4 个主流医学数据库,找到了关于阿司匹林与复方丹参滴丸联合使用对中老年冠心病患者血液流变学和血脂影响的随机对照试验(RCT)。纳入符合研究要求的 RCT;提取数据信息,并使用 Cochrane 偏倚风险评估工具进行质量评估。通过 RevMan 软件对总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、红细胞压积、高切粘度、低切粘度、血浆粘度、PAGM、TXB 有效率进行 Meta 分析。计算相对风险(RR)和 95%置信区间(95%);测试异质性并找出其来源;通过 Egger 和 Begg 检验以及漏斗图评估发表偏倚。

共发现 22 项 RCT,涉及 1987 例患者。Meta 分析结果表明,与单独药物治疗相比,阿司匹林与复方丹参滴丸联合使用对中老年冠心病患者血液流变学和血脂的治疗效果更佳。荟萃分析结果显示对 TC [MD = -0.91, 95% CI (-1.09, -0.73)]、TG [MD = -0.94, 95% CI (-1.22, -0.66)]、HDL-C [MD = 0.40, 95% CI (0.27, 0.53)]、LDL-C [MD = -0.99, 95% CI (-1.24, -0.74)]、红细胞压积 [MD = -2.69, 95% CI (-3.73, -1.65)]、高切血粘度 [MD = -1.11, 95% CI (-2.18, -0.05)]、低切血粘度 [MD = -0.79, 95% CI (-0.89, -0.68)]、血浆粘度 [MD = -0.26, 95% CI (-0.52, 0.01)]、PAMG [MD = -10.75, 95% CI (-16.84, -4.67)]、TXB [MD = -11.84, 95% CI (-14.75, -8.92)]的治疗效果更佳。异质性的来源可能与患者的状态、对照组药物的疗效以及疗效判断标准的差异有关。Egger 检验和 Begg 检验表明,我们的研究没有发表偏倚。

复方丹参滴丸 DSP 与阿司匹林联合使用对 CHD 患者的血脂和血液流变学有一定的治疗作用,由于一些 RCT 样本量很小,我们研究结论的可靠性和有效性可能受到影响;因此,对我们的研究结果的解释应持谨慎态度。未来仍需要大量高质量的 RCT 来证实我们的研究结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c8d/8249928/40c4b89335f4/fpubh-09-664841-g0013.jpg
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