中药注射液治疗非ST段抬高型急性冠脉综合征的系统评价与贝叶斯网状Meta分析

Systematic review and bayesian network Meta-analysis of traditional Chinese medicine injections for the treatment of non-ST-segment elevation acute coronary syndrome

关键词:  非ST段抬高型急性冠脉综合征  中药注射液  网状Meta分析

Key words:  non-ST-segment elevation acute coronary syndrome  traditional Chinese medicine injection  network Meta-analysis

摘要:

[目的] 系统评价中药注射液治疗非ST段抬高型急性冠脉综合征（NSTE-ACS）的疗效与安全性，并比较不同中药注射液的治疗效果。[方法] 检索中国知网（CNKI）、万方数据知识服务平台（Wanfang）、维普数据库（VIP）、PubMed、Embase、Web of Science等数据库，自建库之日至2025年9月1日，纳入符合标准的随机对照试验（RCT）。采用Review Manager 5.4进行系统Meta分析，使用R 4.1.2与RStudio 1.4.1调用相关R包开展贝叶斯网状Meta分析。[结果] 共纳入33项RCT，涉及3 181例NSTE-ACS患者。Meta分析结果显示，在西医常规治疗基础上联合中药注射液可以显著提高临床总有效率与心电图改善率，降低主要不良心血管事件（MACE）发生率及C反应蛋白水平。贝叶斯网状Meta分析结果显示：1）提高临床总有效率方面，大株红景天注射液 > 疏血通注射液 > 银杏达莫注射液 > 参麦注射液 > 丹红注射液。2）降低MACE事件发生率方面，参麦注射液 > 大株红景天注射液 > 血必净注射液。3）降低C反应蛋白方面，丹参酮ⅡA磺酸钠注射液 > 血必净注射液 > 丹红注射液。[结论] 在西医常规治疗基础上联合中药注射液可以改善NSTE-ACS患者的临床结局，显示出较好的疗效与安全性。不同中药注射液的疗效存在差异，但受限于纳入研究质量偏低及结果指标不全，仍然需要更多高质量RCT验证。

Abstract:

[Objective] To systematically evaluate the efficacy and safety of traditional Chinese medicine（TCM） injections in the treatment of non-ST-segment elevation acute coronary syndrome（NSTE-ACS）and to compare the therapeutic effects of different TCM injections. [Methods] Literature searches were performed in CNKI，Wanfang， VIP，PubMed，Embase，and Web of Science databases from their inception to September 1，2025. Eligible randomized controlled trials（RCTs）were included. Review Manager 5.4 was used for conventional meta-analysis， and R 4.1.2 with RStudio 1.4.1 was employed to conduct Bayesian network meta-analysis using relevant R packages. [Results] A total of 33 RCTs involving 3 181 patients with NSTE-ACS were included. The meta-analysis showed that，compared with conventional Western medical treatment alone，the addition of TCM injections significantly improved overall clinical efficacy and electrocardiogram（ECG）improvement rates，and reduced the incidence of major adverse cardiovascular events（MACE）and C-reactive protein（CRP）levels. The Bayesian network Meta-analysis revealed that：1）for improving total clinical efficacy，Rhodiola Injection > Shuxuetong Injection > Ginkgo-Damole Injection > Shenmai Injection>Danhong Injection. 2）For reducing MACE incidence，Shenmai Injection > Rhodiola Injection > Xuebijing Injection. 3）For lowering CRP levels，Sodium Tanshinone ⅡA Sulfonate Injection > Xuebijing Injection > Danhong Injection. [Conclusion] The combination of TCM injections with conventional Western therapy can improve clinical outcomes in NSTE-ACS patients and demonstrates good efficacy and safety. Although differences exist among various TCM injections，the overall quality of the included studies was low and outcome reporting was incomplete；therefore，further high-quality RCTs are warranted to validate these findings.