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冠心舒通胶囊治疗冠心病心绞痛心血瘀阻证的临床综合评价

[Clinical comprehensive evaluation of Guanxin Shutong Capsules in treatment of coronary heart disease angina pectoris with heart blood stasis syndrome].

作者信息

Cui Xin, Han Sheng, Li Jun, Li Wei, Wang Zhi-Fei, Zhang Qiang, Xie Yan-Ming

机构信息

Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China.

International Research Center for Medicinal Administration, Peking University Beijing 100191, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2022 Mar;47(6):1469-1475. doi: 10.19540/j.cnki.cjcmm.20211118.501.

Abstract

This study aims to comprehensively summarize articles on the treatment of coronary heart disease angina pectoris with heart blood stasis syndrome(CHD-AP-HBSS) by Guanxin Shutong Capsules(GSC), and comprehensively evaluate the evidence and value of the formula in "6+1" dimensions based on multi-criteria decision analysis(MCDA) model and Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021) with quantitative and qualitative methods, which is expected to highlight the clinical characteristics and advantages of the prescription and serve as a reference for medical and health departments. The dimensions are grade A, B, C, or D. In terms of safety, according to the reports from the spontaneous reporting system of National Center for ADR Monitoring, and literature analysis, GSC mainly results in the adverse reactions of mild or moderate nausea, diarrhea, rash, palpitation, and headache, with favorable prognosis in patients. Nevertheless, severe adverse reactions have been reported after marketing. Thus, additional evidence for its safety should be accumulated, and the current safety is grade B. Meta-analysis proves that GSC in combination with conventional treatment is superior to conventional treatment alone in alleviating AP and symptoms indicated by electrocardiogram(ECG). Therefore, the effectiveness of the medicine is grade A. As for the pharmacoeconomic value, based on the assumption that the per capita disposable income in 2020 is the willingness-to-pay threshold, it is more economical for CHD-AP patients to use GSC combined with conventional treatment than conventional treatment alone. However, as the currently available clinical parameters fail to support the difference in indirect cost between the two groups, the accuracy in the cost of intervention plan needs to be further improved. Therefore, the economy of the prescription is grade B. GSC has been awarded 13 national invention patents and 1 utility model patent, and won a lot of national and provincial patent awards, marking the enterprise service awareness and innovativeness. As a result, it is grade A in aspect of innovation. A questionnaire on the suitability of GSC suggests that publicity and promotion influence patients' choice and thus additional efforts should be made in this aspect. The suitability of this formula is grade B. Both rural and urban residents can afford the medicine for the whole course and the price is close to that of similar Chinese patent medicines. In addition, it is accessible regardless of season and place, so accessibility is grade A. As a Mongolian empirical formula destined to treat heart stabbing pain, it has the effects of activating blood and resolving stasis, dredging channels and activating collaterals, and moving Qi to relieve pain, and boasts the empirical evidence of more than 2 000 human cases. With prominent characteristics of traditional Chinese medicine, it is grade B. Based on the MCDA model and CSC v2.0, GSC is comprehensively class A in the treatment of CHD-AP-HBSS. The result can serve as a reference for basic clinical medication management.

摘要

本研究旨在全面总结冠心舒通胶囊治疗冠心病心绞痛心血瘀阻证的相关文献,并基于多标准决策分析(MCDA)模型和《药物综合临床评价管理指南(2021年试行版)》,采用定量与定性方法,从“6 + 1”维度综合评价该方剂的证据及价值,以期凸显该方剂的临床特点与优势,为医疗卫生部门提供参考。这些维度分为A、B、C或D级。在安全性方面,根据国家药品不良反应监测中心自发报告系统的报告及文献分析,冠心舒通胶囊主要引起轻度或中度恶心、腹泻、皮疹、心悸及头痛等不良反应,患者预后良好。然而,上市后有严重不良反应的报告。因此,应积累更多关于其安全性的证据,目前其安全性为B级。荟萃分析证明,冠心舒通胶囊联合常规治疗在缓解心绞痛及改善心电图所示症状方面优于单纯常规治疗。因此,该药物的有效性为A级。在药物经济学价值方面,假设以2020年人均可支配收入作为支付意愿阈值,冠心病心绞痛患者使用冠心舒通胶囊联合常规治疗比单纯常规治疗更经济。然而,由于目前可用的临床参数无法支持两组间间接成本的差异,干预方案成本的准确性有待进一步提高。因此,该方剂的经济性为B级。冠心舒通胶囊已获得13项国家发明专利和1项实用新型专利,并荣获多项国家及省级专利奖项,标志着企业的服务意识和创新性。因此,其创新性方面为A级。一项关于冠心舒通胶囊适用性的问卷调查表明,宣传推广影响患者选择,因此在这方面应加大力度。该方剂的适用性为B级。城乡居民均可负担全程用药费用,且价格与同类中成药相近。此外,无论季节和地点均可获得,所以可及性为A级。作为治疗心痛彻背的蒙医经验方,具有活血化瘀、通经活络、理气止痛之功效,并有2000余例人体病例的实证依据。具有突出的中医特色,为B级。基于MCDA模型和CSC v2.0,冠心舒通胶囊在治疗冠心病心绞痛心血瘀阻证方面综合评定为A级。研究结果可为基层临床用药管理提供参考。

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