丹参多酚酸盐注射液对急性冠脉综合征介入术后MACE事件发生率及血管内皮功能影响的Meta分析

Meta-analysis of the effect of salvia miltiorrhiza polyphenolate injection on the incidence of mace events and vascular endothelial function after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS)

关键词:  丹参多酚酸盐注射液  急性冠脉综合征  PCI术后  血管内皮功能  Meta分析  GRADE评价

Key words:  salvianolate  acute coronary syndrome  after percutaneus coronary intervention  vascular endothelial function  Meta-analysis  GRADE evaluation

摘要:

[目的] 系统评价丹参多酚酸盐注射液对急性冠脉综合征（ACS）经皮冠状动脉介入治疗（PCI）术后主要不良心血管事件（MACE）及血管内皮功能的影响。[方法] 计算机检索PubMed、The Cochrane Library、Web of Science、中国知网数据库（CNKI）、万方数据库（WanFang Data）和维普资讯中文科技期刊数据库（VIP），搜集丹参多酚酸盐注射液治疗急性冠脉综合征PCI术后的随机对照试验（RCT），检索时限从建库至2022年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3 软件进行Meta分析。[结果] 共纳入16个RCT，包括1 843例患者，试验组944例，对照组899例。Meta分析结果显示，与常规西药相比，丹参多酚酸盐注射液联合常规西药可降低ACS患者PCI术后MACE发生率[RR=0.35，95%CI（0.24，0.51），P<0.000 01]；降低内皮素-1（ET-1）[SMD= -1.57，95%CI（-2.10，-1.04），P<0.000 01]、丙二醛（MDA）[MD=-1.98，95%CI（-2.09，-1.88），P<0.000 01]、高敏C反应蛋白（hs-CRP）[SMD=-1.76，95%CI（-2.19，-1.33），P<0.000 01]及C反应蛋白（CRP）[SMD=-1.25，95%CI（-1.64，-0.87），P<0.000 01]水平；提高血管内皮一氧化氮（NO）[SMD=1.34，95%CI（0.97，1.72），P<0.000 01]、超氧化物歧化酶（SOD）[MD=51.74，95%CI（49.04，54.44），P<0.000 01]水平和左室射血分数（LVEF）[MD=7.22，95%CI（6.27，8.16），P<0.000 01]。[结论] 丹参多酚酸盐注射液联合常规西药可降低急性冠脉综合征PCI术后MACE事件发生率，改善血管内皮功能及LVEF。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。

Abstract:

[Objective] To evaluate the effects of salvia miltiorrhiza polyphenolate injection on mace events and vascular endothelial function after percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）. [Methods] The computer searches PubMed，the Cochrane Library，web of science，CNKI，Wanfang Data and VIP databases. Randomized controlled trial of salvia miltiorrhiza polyphenolate injection in the treatment of acute coronary syndrome after PCI was collected. The retrieval time was from the establishment of the database to June 2022. After two researchers independently screened the literature，extracted data and evaluated the risk of bias included in the study，Revman 5.3 software was used for meta-analysis. [Results] A total of 16 RCTs were included，including 1 843 patients. Meta-analysis showed that compared with conventional Western medicine，salvia miltiorrhiza polyphenolate injection combined with conventional Western medicine could reduce the incidence of major cardiovascular adverse events （MACE） after PCI in patients with ACS[RR=0.35，95%CI（0.24，0.51），P<0.000 01]. Decrease the levels of endothelin-1 （ET-1）[SMD=-1.57，95%CI（-2.10，-1.04），P<0.000 01]，malondialdehyde （MDA） [MD=-1.98，95%CI（-2.09，-1.88），P<0.000 01]，high-sensitivity C-reactive protein （hs-CRP）[SMD=-1.76，95%CI（-2.19，-1.33），P<0.000 01] and C-reactive protein （CRP）[SMD=-1.25，95%CI（-1.64，-0.87），P<0.000 01]；Increase the level of vascular endothelial nitric oxide （NO）[SMD=1.34，95%CI（0.97，1.72），P<0.000 01]，superoxide dismutase （SOD） [MD=51.74，95%CI（49.04，54.44），P<0.000 01] and left ventricular ejection fraction （LVEF） [MD=7.22，95%CI（6.27，8.16），P<0.000 01]. [Conclusion] Salvia miltiorrhiza polyphenolate injection combined with conventional Western medicine can reduce the incidence of mace events after PCI for acute coronary syndrome and improve vascular endothelial function and left ventricular ejection fraction. Limited by the number and quality of included studies，the above conclusions need to be verified by more high-quality studies.