Wang Wei, Kong Fan-Ting, Li Rui, Zhao Xin-Ke, Li Ying-Dong, Liu Kai
Gansu University of Chinese Medicine Lanzhou 730000, China.
Affiliated Hospital of Gansu University of Chinese Medicine Lanzhou 730000, China.
Zhongguo Zhong Yao Za Zhi. 2024 Jan;49(1):251-267. doi: 10.19540/j.cnki.cjcmm.20231016.501.
This study aims to evaluate the efficacy and safety of Chinese medicine injection in the treatment of acute heart failure. PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang, and SinoMed were searched for the randomized controlled trial(RCT) of Chinese medicine injection combined with conventional western medicines in the treatment of acute heart failure with the time interval from the inception to July 10, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata 15.1 was used to perform network Meta-analysis. A total of 117 RCTs were included, involving 10 529 patients and 7 Chinese medicine injections: Shenfu Injection, Shenmai Injection, Danhong Injection, Puera-rin Injection, Xinmailong Injection, Shengmai Injection, and Yiqi Fumai Injection. Network Meta-analysis yielded the following results.(1) In terms of improving the total response rate, the surface under the cumulative ranking curve(SUCRA) ranking was Shengmai Injection + conventional western medicine > Danhong Injection + conventional western medicine > Shenmai Injection + conventio-nal western medicine > Shenfu Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Puerarin Injection + conventional western medicine > conventional western medicine.(2)In terms of reducing brain natriuretic peptide(BNP), the SUCRA ranking was Danhong Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Puerarin Injection + conventional wes-tern medicine > Shengmai Injection + conventional western medicine > conventional western medicine.(3)In terms of reducing N-terminal pro-brain natriuretic peptide(NT-proBNP), the SUCRA ranking was Shenmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Puerarin Injection + conventional western medicine > Danhong Injection + conventional western medicine > conventional western medicine.(4) In terms of improving the left ventricular ejection fraction(LVEF), the SUCRA ranking was Shenmai Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Puerarin Injection + conventional western medicine > Danhong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > conventional western medicine.(5) In terms of decreasing the left ventricular end-diastolic diameter(LVEDD), the SUCRA ranking was Shenmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine=Xinmailong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > conventional western medicine > Puerarin Injection + conventional western medicine.(6) In terms of increasing the 6-min walk trail(6MWT), the SUCRA ranking was Xinmailong Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > conventional western medicine.(7) In terms of reducing the Minnesota heart failure quality of life scale(MLHFQ) scores, the SUCRA ranking was Xinmailong Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > conventional western medicine.(8)In terms of safety, the group of Chinese medicine injection combined with conventional western medicine had lower incidence of adverse reactions than the control group. The current evidence shows that combining Chinese medicine injection with conventional western medicine treatment can improve the therapeutic effect on acute heart failure, with high safety. Due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.
本研究旨在评价中药注射剂治疗急性心力衰竭的有效性和安全性。检索了PubMed、Cochrane图书馆、EMbase、Web of Science、中国知网、维普、万方和中国生物医学文献数据库，查找自建库至2023年7月10日期间中药注射剂联合传统西药治疗急性心力衰竭的随机对照试验（RCT）。两名研究者独立筛选文献、提取数据并评估纳入研究的偏倚风险。采用Stata 15.1软件进行网状Meta分析。共纳入117项RCT，涉及10529例患者和7种中药注射剂：参附注射液、参麦注射液、丹红注射液、葛根素注射液、心脉隆注射液、生脉注射液和益气复脉注射液。网状Meta分析得出以下结果。（1）在提高总有效率方面，累积排序曲线下面积（SUCRA）排名为：生脉注射液+传统西药＞丹红注射液+传统西药＞参麦注射液+传统西药＞参附注射液+传统西药＞心脉隆注射液+传统西药＞益气复脉注射液+传统西药＞葛根素注射液+传统西药＞传统西药。（2）在降低脑钠肽（BNP）方面，SUCRA排名为：丹红注射液+传统西药＞心脉隆注射液+传统西药＞益气复脉注射液+传统西药＞参附注射液+传统西药＞参麦注射液+传统西药＞葛根素注射液+传统西药＞生脉注射液+传统西药＞传统西药。（3）在降低N末端B型脑钠肽原（NT-proBNP）方面，SUCRA排名为：参麦注射液+传统西药＞益气复脉注射液+传统西药＞心脉隆注射液+传统西药＞生脉注射液+传统西药＞参附注射液+传统西药＞葛根素注射液+传统西药＞丹红注射液+传统西药＞传统西药。（4）在提高左心室射血分数（LVEF）方面，SUCRA排名为：参麦注射液+传统西药＞心脉隆注射液+传统西药＞参附注射液+传统西药＞益气复脉注射液+传统西药＞葛根素注射液+传统西药＞丹红注射液+传统西药＞生脉注射液+传统西药＞传统西药。（5）在减小左心室舒张末期内径（LVEDD）方面，SUCRA排名为：参麦注射液+传统西药＞参附注射液+传统西药=心脉隆注射液+传统西药＞生脉注射液+传统西药＞益气复脉注射液+传统西药＞传统西药＞葛根素注射液+传统西药。（6）在增加6分钟步行试验（6MWT）方面，SUCRA排名为：心脉隆注射液+传统西药＞参附注射液+传统西药＞参麦注射液+传统西药＞益气复脉注射液+传统西药＞传统西药。（7）在降低明尼苏达心力衰竭生活质量量表（MLHFQ）评分方面，SUCRA排名为：心脉隆注射液+传统西药＞参麦注射液+传统西药＞参附注射液+传统西药＞传统西药。（8）在安全性方面，中药注射剂联合传统西药组的不良反应发生率低于对照组。当前证据表明，中药注射剂联合传统西药治疗可提高急性心力衰竭的治疗效果，安全性高。由于纳入研究的数量和质量有限，上述结论需要更多高质量研究加以验证。
