PCI术后中西药联用的临床研究现状分析

Analysis of status on clinical research of integrative Chinese and Western medicine treatments after percutaneous coronary intervention

关键词:  经皮冠脉介入术后  联合用药  抗血小板  活血化瘀

Key words:  after PCI  integrative medicine  antiplatelet agents  activating blood and removing blood stasis

摘要:

[目的] 调查经皮冠脉介入（PCI）术后中西药联合应用研究的现状。[方法] 计算机检索CNKI、WANFANG Date、Sinomed、Pubmed、Embase、Web of Science、Cochrane Library 7个数据库，筛选PCI术后中西药联合应用的临床随机对照试验（RCT），由2位研究者严格按照纳入与排除标准独立筛选文献、提取资料，如有分歧，经讨论解决。[结果] 共纳入740篇RCT。对联用的西药进行分析，最常用的是抗血小板药物：有59.2%的研究使用双联抗血小板药物（其中8.4%仅使用双联抗血小板，50.8%为双联抗血小板联合其他西药，包括抗凝药、他汀类、β受体阻滞剂、硝酸酯类、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、钙离子拮抗剂等）；7.3%为单联抗血小板联合其他西药；4.7%的研究联合用药信息报告不清但未提及抗血小板治疗。28.8%的研究提及使用西医常规疗法，具体药品名称未报告。联用的中药包括中成药和汤剂等：39.9%的研究使用口服中成药，共包括100个品种，频次排名前3的为通心络胶囊（8.1%）、复方丹参滴丸（3.1%）、通冠胶囊（1.6%），均为活血化瘀制剂；27.0%的研究使用中药注射剂，共31种，频次排名前3的为丹红注射液（6.6%）、丹参多酚酸盐注射液（3.4%）、疏血通注射液（2.7%），均为活血化瘀药物；33.9%的研究使用汤剂，包括自拟汤剂（25.7%）和经典汤剂（8.2%）；0.4%的研究使用单味中药，共3种，包括丹参、圣约翰草、人参。就联合用药而言，共有454种中西药联用组合，频次排名前3分别为自拟汤剂联合西药常规（8.0%）、通心络胶囊联合西药常规（2.4%）、自拟汤剂联合双联抗血小板+他汀类（2.0%）。[结论] PCI术后联用的中西药种类、数量较多，联用组合多样化，西药以双联抗血小板为主，中药以活血化瘀药物为主。临床研究报告存在诸多问题，联用药品名称、用法、用量、疗程等信息报告不完整。联合用药的合理性和科学性有待深入研究。

Abstract:

[Objective] To investigate the status of clinical research on integrative medicine treatments after percutaneous coronary intervention(PCI).[Methods] Seven databases including CNKI, WANFANG Data, Sinomed, Pubmed, Embase, Web of science, Cochrane Library were retrieved to collect randomized controlled trials (RCTs) about integrative medicine treatments for patients after PCI. Two reviewers independently screened literature and extracted data according to the inclusion and exclusion criteria. Disagreements were resolved by discussion.[Results] A total of 740 RCTs were included for analysis. Antiplatelet agents were most commonly used in the analysis of western medicines. The 59.2% of the studies used dual antiplatelet therapy (of which 8.4% used only dual antiplatelets, 50.8% used dual antiplatelets combined with other western drugs, including anticoagulants, statins, beta-blockers, nitrates, angiotensin converting enzyme inhibitors, angiotensin Ⅱ receptor antagonists, calcium antagonists, etc.). The 7.3% of the studies used single antiplatelet combined with other western medicines. The 4.7% did not mention antiplatelet therapy. 28.8% of the studies mentioned the use of conventional western medicine, but the specific drug names were not reported. Chinese patent medicine and decoction were most commonly used in the analysis of traditional Chinese medicine. The 39.9% of the studies used oral Chinese patent medicine, including 100 varieties. The top 3 were Tongxinluo capsule (8.1%), compound salvia miltiorrhiza dropping pills (3.1%) and Tongguan capsule (1.6%). The 27% of the studies used traditional Chinese medicine injections, including 31 varieties. The top 3 were Danhong injection (6.6%), Salvia miltiorrhiza polysalinate injection (3.4%) and Shuxuetong injection (2.7%), which were all drugs for activating blood and removing blood stasis. The 33.9% of the studies used decoction, including self-made decoction (25.7%) and classical decoction (8.2%). The 0.4% of the studies used single herb, including 3 varieties which were Salvia miltiorrhiza and Saint John. Grass and ginseng. There were 454 combinations between Chinsese and western drug. The top 3 included self-made decoction combined with conventional western medicine(8.0%), Tongxinluo capsule combined with conventional western medicine(2.4%), self-made decoction combined with dual antiplatelet therapy and statins.[Conclusion] There are numerous kinds and quantities of Chinese and Western medicine in integrative medicine studies after PCI. Dual antiplatelet therapies and drugs for activating blood and removing blood stasis were mainly used. Meanwhile, lots of problems were found in the clinical research, and the information reporting is not complete. Thus, the rationality and scientificity of integrative medicine need to be further studied.