摘要
目的采用贝叶斯网状Meta分析方法评价复方丹参滴丸与硝酸异山梨酯、单硝酸异山梨酯对比或联用治疗心绞痛的临床疗效。方法计算机检索Cochrane Library、Pub Med、EMbase、中国知网、万方、维普数据库,检索时间截至2017年12月10日,纳入复方丹参滴丸与硝酸异山梨酯、单硝酸异山梨酯对比或联用治疗心绞痛的随机对照研究,采用End Note X8进行文献管理和去重。根据《Cochrane系统评价员手册》(5.3.3版)对纳入研究的质量进行评价,采用Rev Man 5.0绘制风险评估图。网状Meta分析采用R软件(V.3.4.4)Gemtc程序包通过马尔科夫链-蒙特卡洛(MCMC)方法进行分析,使用等级排序概率表不同干预措施疗效优劣概率排序,Stata14.0绘制漏斗图以评估发表偏倚。直接Meta分析采用Rev Man5.0软件进行分析。结果共纳入41篇随机对照试验,包括4 679名患者。网状Meta分析结果:(1)心绞痛临床疗效(n=41)中复方丹参滴丸疗效最优的概率最大,复方丹参滴丸疗效优于硝酸异山梨酯、单硝酸异山梨酯[OR=3.7,95%Crl(2.9,4.7);OR=4.3,95%Crl(1.7,13)],复方丹参滴丸+硝酸异山梨酯优于硝酸异山梨酯[OR=2.5,95%Crl(1.5,4.4)],复方丹参滴丸+单硝酸异山梨酯优于单硝酸异山梨酯[OR=3.6,95%Crl(2.4,5.5)];(2)心电图临床疗效(n=30)中复方丹参滴丸+单硝酸异山梨酯疗效最优概率最大,复方丹参滴丸优于硝酸异山梨酯[OR=2.7,95%Crl(2.2,3.3)],复方丹参滴丸+硝酸异山梨酯优于硝酸异山梨酯[OR=2.9,95%Crl(1.8,5.1)],复方丹参滴丸+单硝酸异山梨酯优于硝酸异山梨酯、单硝酸异山梨酯[OR=6.2,95%Crl(2.3,17);OR=3.8,95%Crl(2.5,5.9)];(3)不良反应(n=26)中复方丹参滴丸不良反应最小概率最大,复方丹参滴丸不良反应较硝酸异山梨酯、单硝酸异山梨酯较小[OR=0.036,95%Crl(0.0061,0.093);OR=0.049,95%Crl(0.0022,0.40)],联用时不增加硝酸酯类不良反应。与直接Meta分析结果基本一致。结论复方丹参滴丸对
Objective To evaluate the safety and efficacy of Fufangdanshen dripping pills,isosorbide nitrate and isosorbide mononitrate in treating angina by Bayesian network meta-analysis.Methods Randomized controlled trials comparing Fufangdanshen dripping pills,isosorbide nitrate and isosorbide ononitrate in treating angina were searched in the Cochrane Library,PubMed,EMBASE,CNKI,Wanfang and Weipu databases.Search time was as of December 10,2017.The EndNote X8 was used to document management and deduplication.Cochrane Reviewers handbook(5.3.3)was used to evaluate quality of studies included.The risk of bias was evaluated by RevMan(V.5.0).The Gemtc package of R software(V.3.4.4)was used to carry out Bayesian network meta-analysis through the Markov chain-Monte Carlo(MCMC).Rank probabilities were used to evaluate efficacy of different treatments.Stata 14.0 draws funnel maps were used to evaluate publication bias.Direct meta-analysis was evaluated by RevMan(V.5.0).Results 41 RCTs and 4 679 patients were included.Network meta-analysis shows:①Probability of the efficacy of Fufangdanshen dripping pills was the biggest in angina clinical efficacy(n=41),Fufangdanshen dripping pills was more effective than isosorbide nitrate and isosorbide mononitrate[OR=3.7,95%Crl(2.9,4.7),OR=4.3,95%Crl(1.7,13)],Fufangdanshen dripping pills+isosorbide nitrate is more effective than isosorbide nitrate[OR=2.5,95%Crl(1.5,4.4)],Fufangdanshen dripping pills+isosorbide mononitrate was more effective than isosorbide mononitrate[OR=3.6,95%Crl(2.4,5.5)];②Probability of the efficacy of Fufangdanshen dripping pills+isosorbide mononitrate was the biggest in ECG clinical efficacy(n=30),Fufangdanshen dripping pills was more effective than isosorbide nitrate[OR=2.7,95%Crl(2.2,3.3)],Fufangdanshen dripping pills+isosorbide nitrate was more effective than isosorbide nitrate[OR=2.9,95%Crl(1.8,5.1)],Fufangdanshen dripping pills+isosorbide mononitrate was more effective than isosorbide nitrate and isosorbide mononitrate[OR=6.2,95%Crl(2.3,17);OR=3.8,95%Crl(2.5,5.9
作者
张丹丹
刘欢
陈嘉音
金晶
熊尧
杨悦
ZHANG Dandan;LIU Huan;CHEN Jiayin;JIN Jing;XIONG Yao;YANG Yue(School of Life Science and Biopharmaceutics,Shenyang Pharmaceutical University,Liaoning Shenyang 110016,China;School of Business Administration,Shenyang Pharmaceutical University,Liaoning Shenyang 110016,China;International Food&Drug Policy and Law Research Center,Liaoning Shenyang Pharmaceutical University,Liaoning Shenyang 110016,China;School of Public Administration,Southwestern University of Finance and Economics,Sichuan Chengdu 611130,China)
出处
《中国药物警戒》
2018年第7期419-428,433,共11页
Chinese Journal of Pharmacovigilance
