中西医结合防治动脉硬化闭塞症术后再狭窄安全性及临床疗效的Meta分析

摘要

目的：系统评价中西医结合与单纯西药疗法治疗动脉硬化闭塞症术后再狭窄的安全性及临床疗效。方法计算机检索中国期刊全文数据库、万方数据库、维普中文科技期刊数据库、PubMed 、EMBASE、chochrane图书馆，然后对符合纳入标准和排除标准的随机对照试验进行筛选，对纳入研究的文献进行数据提取，并统计数据进行合并，对文献质量进行方法学评价，最后根据异质性大小选用固定效应模型和随机效应模型进行系统分析。结果共有10篇随机对照试验纳入研究，6篇文献对术后6个月有效率进行了报道： RR＝1．16，95％CI（1．06，1．27）；3篇文献对术后6个月显效率进行了报道：RR＝16．0，95％CI（1．01，2．55）；3篇文献对术后3个月有效率进行了报道：RR＝1．22，95％CI （1．08，1．37）。10篇文献中5篇对术后6个月的踝肱指数（ABI）进行了统计：RR＝0．19，95％CI（0．08，0．29）；10篇文献中3篇对术后3个月的ABI进行了统计：RR＝0．21，95％CI（0．17，0．26）。结论 Meta分析表明中西医结合疗法对于动脉硬化闭塞症术后再狭窄疗效优于单纯西药，可以改善术后3个月和6个月的有效率，改善术后3个月和6个月的ABI，但纳入研究的文献质量均不高，另外由于符合纳入标准的文献数量较少和部分文献的发表偏倚和低质量偏倚，还不能得到较为肯定的结论。%Objective It is to discuss the safety and clinical efficacy about therapy Combined traditional Chinese and Western medicine in the prevention and treatment of arteriosclerosis obliterans restenosis after the surgery .Method We searched the Chinese databases:CNKI, Wan Fang Chinese periodical database , Weipu Chinese periodical database and for-eign language databases:PubMed, EMBASE, chochrane library.We screened the randomized controlled trials that matched the inclusion and exclusion criteria , extracted the data of the study , and merged the statistical data , then made a methodology evaluation about the quality of the literature , last we made the system analysis about literature evaluation with fixed effect mod-el and random effect model according to the size of the heterogeneity .Results A total of 10 randomized controlled trials were included in the study , 6 articles had reported the efficiency after 6 months:RR=1.16, 95%CI (1.06,1.27);3 articles had reported the significant efficiency after 6 months:RR=1.60, 95% CI (1.01,2.55);3 articles had reported the efficiency after 3 months:RR=1.22, 95% CI(1.08,1.37).In the 10 literature, five papers had statistical data of ABI after 6 months :RR =0.19, 95%CI (0.08,0.29);3 papers had statistical data of ABI after 3 months:RR =0.21, 95%CI (0. 17,0.26).Conclusion Meta-analysis showed that therapy combined traditional Chinese and western medicine for arterioscle -rosis obliterans restenosis were more effective than Western medicine alone .It can improve the efficiency and ABI after 3 months and 6 months .However, the quality of the included studies were not well enough , in addition, the number of docu-ments that meeting the inclusion criteria were not enough and parts of documents had publication bias and low quality bias , so we still can not get a more definite conclusion .