Kan Zunqi, Yan Wenli, Yang Mengqi, Gao Huanyu, Meng Dan, Wang Ning, Fang Yuqing, Wu Lingyu, Song Yongmei
College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Institute for Literature and Culture of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Front Pharmacol. 2023 Mar 7;14:1144419. doi: 10.3389/fphar.2023.1144419. eCollection 2023.
Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) therapy may experience further damage to the vascular endothelium, leading to increased inflammatory response and in-stent thrombosis. In many clinical studies, sodium tanshinone IIA sulfonate injection (STS) has been found to reduce inflammatory factors and enhance vascular endothelial function in patients with ACS while improving the prognosis of PCI. However, to date, there has been no systematic review assessing the effectiveness and safety of STS on inflammatory factors and vascular endothelial function. The aim of this study is to systematically review the effects of STS on inflammatory factors and endothelial function in patients with ACS treated with PCI. Until October 2022, eight literature databases and two clinical trial registries were searched for randomized controlled trials (RCTs) investigating STS treatment for ACS patients undergoing PCI. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool 2.0. Meta-analysis was performed using RevMan 5.4 software. Seventeen trials met the eligibility criteria, including 1,802 ACS patients undergoing PCI. The meta-analysis showed that STS significantly reduced high-sensitivity C-reactive protein (hs-CRP) levels (mean difference [MD = -2.35, 95% CI (-3.84, -0.86), = 0.002], tumor necrosis factor-alpha (TNF-α) levels (standard mean difference [SMD = -3.29, 95%CI (-5.15, -1.42), = 0,006], matrix metalloproteinase-9 (MMP-9) levels [MD = -16.24, 95%CI (-17.24, -15.24), < 0.00001], and lipid peroxidation (LPO) levels [MD = -2.32, 95%CI (-2.70, -1.93), < 0.00001], and increased superoxide dismutase (SOD) levels [SMD = 1.46, 95%CI (0.43, 2.49), = 0,006] in patients with ACS. In addition, STS significantly decreased the incidence of major adverse cardiovascular events (relative risk = 0.54, 95%CI [0.44, 0.66], < 0.00001). The quality of evidence for the outcomes was assessed to be very low to medium. STS can safely and effectively reduce the levels of hs-CRP, TNF-α, MMP-9, and LPO and increase the level of SOD in patients with ACS treated with PCI. It can also reduce the incidence of adverse cardiovascular events. However, these findings require careful consideration due to the small number of included studies, high risk of bias, and low to moderate evidence. In the future, more large-scale and high-quality RCTs will be needed as evidence in clinical practice.
接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者，其血管内皮可能会受到进一步损伤，从而导致炎症反应加剧和支架内血栓形成。在许多临床研究中，已发现丹参酮IIA磺酸钠注射液（STS）可降低ACS患者的炎症因子水平，增强血管内皮功能，同时改善PCI的预后。然而，迄今为止，尚无系统评价评估STS对炎症因子和血管内皮功能的有效性和安全性。本研究旨在系统评价STS对接受PCI治疗的ACS患者炎症因子和内皮功能的影响。截至2022年10月，检索了八个文献数据库和两个临床试验注册库，以查找调查STS治疗接受PCI的ACS患者的随机对照试验（RCT）。使用Cochrane风险评估工具2.0评估纳入研究的质量。使用RevMan 5.4软件进行荟萃分析。17项试验符合纳入标准，包括1802例接受PCI的ACS患者。荟萃分析表明，STS可显著降低ACS患者的高敏C反应蛋白（hs-CRP）水平（平均差[MD]=-2.35，95%可信区间[-3.84，-0.86]，P=0.002）、肿瘤坏死因子-α（TNF-α）水平（标准化平均差[SMD]=-3.29，95%可信区间[-5.15，-1.42]，P=0.006）、基质金属蛋白酶-9（MMP-9）水平[MD=-16.24，95%可信区间[-17.24，-15.24]，P<0.00001]和脂质过氧化（LPO）水平[MD=-2.32，95%可信区间[-2.70，-1.93]，P<0.00001]，并提高超氧化物歧化酶（SOD）水平[SMD=1.46，95%可信区间[0.43，2.49]，P=0.006]。此外，STS可显著降低主要不良心血管事件的发生率（相对风险=0.54，95%可信区间[0.44，0.66]，P<0.00001）。结局的证据质量评估为极低至中等。STS可安全有效地降低接受PCI治疗的ACS患者的hs-CRP、TNF-α、MMP-9和LPO水平，并提高SOD水平。它还可降低不良心血管事件的发生率。然而，由于纳入研究数量少、偏倚风险高以及证据质量低至中等，这些发现需要谨慎考虑。未来，需要更多大规模、高质量的RCT作为临床实践的证据。
