知识泻白桂枝汤治疗冠心病：系统评价和荟萃分析。
Zhishi Xiebai Guizhi Decoction for coronary heart disease: A systematic review and meta-analysis.
机构信息
Office of Academic Affairs, Shandong University of Traditional Chinese Medicine, Jinan, China.
College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
出版信息
Medicine (Baltimore). 2024 Jan 19;103(3):e36588. doi: 10.1097/MD.0000000000036588.
BACKGROUND
Coronary heart disease (CHD) is a type of cardiovascular disease (CVD) caused by coronary atherosclerosis. It is a main cause of medical burden and cardiovascular related death. Zhishi Xiebai Guizhi Decoction (ZXGD) is a representative prescription of traditional Chinese medicine (TCM) in the treatment of CHD, but there is poor systemically evidence-based appraisal.
OBJECTIVE
To evaluate the efficacy and safety of ZXGD for CHD.
METHODS
Eight databases were retrieved for randomized controlled trials (RCTs). Data was extracted independently by 2 reviewers. The quality of the included studies was assessed by Cochrane Collaboration risk of bias tool. Clinical efficacy, blood lipid, vascular endothelial function, inflammatory factor and homocysteine (Hcy) were prespecified outcome measures.
RESULTS
Twenty-four studies (2272 patients) were included. Meta-analysis showed that compared with conventional western medicine (WM) alone, ZXGD was associated with a greater symptom improvement rate with a relative risk (RR) of 1.21 [95% CI (1.16, 1.26), P < .00001] and a greater electrocardiogram (ECG) improvement rate with a RR of 1.27 [95% CI (1.16, 1.40), P < .00001]. In terms of blood lipid, ZXGD reduced total cholesterol (TC) with a mean difference (MD) of -1.15 [95%CI (-1.75, -0.55), P = .0002] and triglyceride (TG) [MD = -0.72, 95%CI (-0.99, -0.45), P < .00001], reduced low-density lipoprotein cholesterol (LDL-C) [MD = -0.93, 95% CI (-1.17, -0.69), P < .00001], and increased high-density lipoprotein cholesterol (HDL-C) [MD = 0.31, 95%CI (0.20, 0.42), P < .00001]. In terms of vascular endothelial function, ZXGD decreased the level of endothelin-1 (ET-1) [MD = -7.81, 95%CI (-9.51, -6.10), P < .00001], and increased nitric oxide (NO) [MD = 8.90, 95%CI (7.86, 9.93), P < .00001]. ZXGD also reduced high-sensitivity C-reactive protein (hs-CRP) [MD = -1.73, 95% CI (-2.63, -0.83), P < .00001] and Hcy [MD = -2.03, 95%CI (-2.78, -1.28), P < .00001]. No significant differences were found in adverse event rate between the 2 groups with a RR of 0.77 [95% CI (0.44, 1.34), P = .36].
CONCLUSION
ZXGD is effective and safe in the treatment of CHD. However, more rigorous and high-quality RCTs are needed to verify the conclusion.
背景
冠心病（CHD）是由冠状动脉粥样硬化引起的心血管疾病（CVD）的一种。它是医疗负担和心血管相关死亡的主要原因。智石燮白桂枝汤（ZXGD）是治疗 CHD 的中药代表方剂，但缺乏系统的循证评价。
目的
评价 ZXGD 治疗 CHD 的疗效和安全性。
方法
检索了 8 个数据库的随机对照试验（RCT）。由 2 名评审员独立提取数据。使用 Cochrane 协作风险偏倚工具评估纳入研究的质量。临床疗效、血脂、血管内皮功能、炎症因子和同型半胱氨酸（Hcy）是预先设定的结局指标。
结果
共纳入 24 项研究（2272 例患者）。Meta 分析显示，与单纯常规西药（WM）相比，ZXGD 与更高的症状改善率相关，相对风险（RR）为 1.21 [95%置信区间（95%CI）（1.16，1.26），P<0.00001]和更高的心电图（ECG）改善率，RR 为 1.27 [95%CI（1.16，1.40），P<0.00001]。在血脂方面，ZXGD 降低总胆固醇（TC）的平均差值（MD）为-1.15 [95%CI（-1.75，-0.55），P=0.0002]和甘油三酯（TG）[MD=-0.72，95%CI（-0.99，-0.45），P<0.00001]，降低低密度脂蛋白胆固醇（LDL-C）[MD=-0.93，95% CI（-1.17，-0.69），P<0.00001]，增加高密度脂蛋白胆固醇（HDL-C）[MD=0.31，95%CI（0.20，0.42），P<0.00001]。在血管内皮功能方面，ZXGD 降低内皮素-1（ET-1）水平[MD=-7.81，95%CI（-9.51，-6.10），P<0.00001]，增加一氧化氮（NO）[MD=8.90，95%CI（7.86，9.93），P<0.00001]。ZXGD 还降低了高敏 C 反应蛋白（hs-CRP）[MD=-1.73，95%CI（-2.63，-0.83），P<0.00001]和同型半胱氨酸（Hcy）[MD=-2.03，95%CI（-2.78，-1.28），P<0.00001]。两组不良反应发生率无显著差异，RR 为 0.77 [95%CI（0.44，1.34），P=0.36]。
结论
ZXGD 治疗 CHD 有效且安全。然而，需要更多严格和高质量的 RCT 来验证这一结论。
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