Dai Lulu, Zhang Ying, Jiang Yuerong, Chen Keji
National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Front Pharmacol. 2022 Dec 7;13:1015048. doi: 10.3389/fphar.2022.1015048. eCollection 2022.
We aimed to evaluate the effects of Panax notoginseng preparations (PNP) containing Panax Notoginseng Saponins (PNS) or Panaxatriol Saponin (PTS) on platelet aggregation and coagulation in the adjuvant treatment of coronary heart disease (CHD) and ischemic stroke (IS). Randomized controlled trials (RCTs) comparing the combination of PNP and aspirin (ASA) ASA alone for CHD or IS were searched in eight databases. Subgroup analysis was performed according to saponin category. When statistical heterogeneity was significant, sensitivity analysis was performed using the leave-one-out approach. Funnel plot, Egger' test, and Begg' test was adopted to detect publication bias. Twenty RCTs involving 2216 patients were analyzed. Compared with ASA alone, PNP plus ASA had a stronger inhibitory effect on in PAgR [PNS, WMD = -6.10 (-7.25, -4.95), < 0.00001; PTS, WMD = -3.53 (-4.68, -2.38), < 0.00001]; PNS plus ASA better reduced FIB [WMD = -0.43 (-0.49, -0.36)] and DD [WMD = -0.59 (-0.67, -0.51), < 0.00001], while PLT ( = 0.07) and PT ( = 0.34) were not significantly different; PTS plus ASA better prolonged PT [WMD = 1.90 (1.47, 2.32), < 0.00001] and PT-INR [WMD = 0.22 (0.11, 0.32), < 0.0001], whereas no significant difference in DD ( = 0.1) and bleeding-related events (positive fecal occult blood, = 0.96; upper gastrointestinal bleeding, = 0.67; subcutaneous hemorrhage, = 0.51; bulbar conjunctival hemorrhage, = 0.51; hematuria, = 0.58). There was no significant difference between PNP plus ASA and ASA alone in terms of gastrointestinal side effect (PNS, = 0.65; PTS, = 0.56) and urticaria (PNS, = 0.57; PTS, = 0.55). PNP combined with ASA might produce stronger antiplatelet aggregation and anticoagulation effects without increasing bleeding risk, gastrointestinal side effects, and urticaria compared with ASA alone. https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022339234.
我们旨在评估含三七总皂苷（PNS）或三七三醇皂苷（PTS）的三七制剂（PNP）在冠心病（CHD）和缺血性中风（IS）辅助治疗中对血小板聚集和凝血的影响。在八个数据库中检索了比较PNP与阿司匹林（ASA）联合用药和单独使用ASA治疗CHD或IS的随机对照试验（RCT）。根据皂苷类别进行亚组分析。当统计异质性显著时，采用留一法进行敏感性分析。采用漏斗图、Egger检验和Begg检验检测发表偏倚。分析了涉及2216例患者的20项RCT。与单独使用ASA相比，PNP加ASA对血小板聚集率（PAgR）的抑制作用更强[PNS，加权均数差（WMD）=-6.10（-7.25，-4.95），P<0.00001；PTS，WMD=-3.53（-4.68，-2.38），P<0.00001]；PNS加ASA能更好地降低纤维蛋白原（FIB）[WMD=-0.43（-0.49，-0.36）]和D-二聚体（DD）[WMD=-0.59（-0.67，-0.51），P<0.00001]，而血小板计数（PLT，P=0.07）和凝血酶原时间（PT，P=0.34）无显著差异；PTS加ASA能更好地延长PT[WMD=1.90（1.47，2.32），P<0.00001]和国际标准化比值（PT-INR）[WMD=0.22（0.11，0.32），P<0.0001]，而DD（P=0.1）和出血相关事件（粪便潜血阳性，P=0.96；上消化道出血，P=0.67；皮下出血，P=0.51；球结膜出血，P=0.51；血尿，P=0.58）无显著差异。PNP加ASA与单独使用ASA在胃肠道副作用（PNS，P=0.65；PTS，P=0.56）和荨麻疹（PNS，P=0.57；PTS，P=0.55）方面无显著差异。与单独使用ASA相比，PNP联合ASA可能产生更强的抗血小板聚集和抗凝作用，且不增加出血风险、胃肠道副作用和荨麻疹。https://www.crd.york.ac.uk/PROSPERO/#recordDetails，标识符CRD42022339234
