摘要
目的系统评估中医药辨证治疗难治性高血压病的有效性和安全性。方法计算机检索中国生物医学文献数据库、中文科技期刊数据库、中国学术期刊数据库、维普数据库、万方数据库、中国知网发表的中医药辨证治疗难治性高血压病的随机对照试验,检索时间从建库至2022年5月15日。使用Cochrane协作网评估工具进行文献资料评价提取,选取降压疗效、收缩压、舒张压、血压达标率、远期降压疗效、肌酐、尿素氮、血尿酸、尿微量白蛋白/肌酐、左心室体积指数、肱踝脉搏波传导速度、踝肱指数、颈动脉内膜中膜复合体厚度及不良反应为评价指标,采用Rev Man 5.3软件进行Meta分析,并根据GRADE指南评价证据等级,评价其安全性。结果最终纳入4项研究,患者572例,其中治疗组354例,对照组218例;纳入的研究方法学质量均不高;Meta分析显示:相比对照组,治疗组能提高临床疗效[RR=-0.17,95%CI(-0.25,-0.09),P<0.0001]、血压达标率[RR=0.36,95%CI(0.13,1.02),P=0.05]、远期疗效[RR=0.25,95%CI(0.17,0.35),P<0.00001],降低舒张压[SMD=-1.22,95%CI(-1.55,-0.89),P<0.00001]和收缩压[MD=-17.56,95%CI(-22.58,-12.72),P<0.00001],改善患者中医临床症状[RR=0.51,95%CI(0.32,0.82),P=0.005]、左心室体积指数[MD=-0.81,95%CI(-13.23,-2.79),P=0.003]、肱踝脉搏波传导速度[MD=-196.73,95%CI(-323.63,-69.83),P=0.002]、踝肱指数[MD=0.11,95%CI(0.04,0.18),P=0.001]、颈动脉内膜中膜复合体厚度[MD=-0.24,95%CI(-0.41,-0.07),P=0.005]和不良反应[RR=0.45,95%CI(0.17,1.20),P=0.11];两组改善尿素氮、血尿酸、肌酐、尿微量白蛋白/肌酐水平比较,差异无统计学意义(P>0.05);依据GRADE指南标准,总有效率、远期疗效、临床症状、舒张压为中级证据,收缩压、血压达标率、肌酐、尿素氮、血尿酸、尿微量白蛋白/肌酐、左心室体积指数、肱踝脉搏波传导速度、踝肱指数、颈动脉内膜中膜复合体厚度、不良反应为极
Objective To systematically evaluate the efficacy and safety of traditional Chinese medicine in the treatment of refractory hypertension.Methods Randomized controlled trials(RCTs)of TCM syndrome differentiation and treatment of refractory hypertension published in Chinese biomedical literature database,Chinese scientific journal database,Chinese academic journal database,VIP database,Wanfang database and China National Knowledge Infrastructure(CNKI)were retrieved by computer.The retrieval time was from the establishment of the database to May 15,2022.Cochrane collaboration network evaluation tool was used to evaluate and extract the literature.The antihypertensive efficacy,systolic blood pressure,diastolic blood pressure,blood pressure compliance rate,long-term antihypertensive efficacy,creatinine,urea nitrogen,serum uric acid,urinary microalbumin/creatinine,left ventricular volume index,brachial-ankle pulse wave velocity,ankle brachial index,carotid intima-media complex thickness and adverse reactions were selected as evaluation indexes.Rev Man 5.3 software was used for Meta analysis,and the evidence level was evaluated according to GRADE guidelines to evaluate its safety.Results Finally,4 studies were included,with 572 patients,including 354 patients in the treatment group and 218 patients in the control group;the methodological quality of the included studies was not high;meta-analysis showed that compared with the control group,the treatment group could improve the clinical efficacy[RR=-0.17,95%CI(-0.25,-0.09),P<0.0001],blood pressure compliance rate[RR=0.36,95%CI(0.13,1.02),P=0.05],long-term efficacy[RR=0.25,95%CI(0.17,0.35),P<0.00001],reduction of diastolic blood pressure[SMD=-1.22,95%CI(-1.55,-0.89),P<0.00001]and systolic blood pressure[MD=-17.56,95%CI(-22.58,-12.72),P<0.00001],improvement of TCM clinical symptoms[RR=0.51,95%CI(0.32,0.82),P=0.005],left ventricular volume index[MD=-0.81,95%CI(-13.23,-2.79),P=0.003],brachial-ankle pulse wave velocity[MD=-196.73,95%CI(-323.63,-69.83),P=0.002],ankle-brachial i
作者
陆新
龙瑾
LU Xin;LONG Jin(Department of Internal Medicine,Guangxi International Zhuang Hospital,Nanning 530001,Guangxi,China)
出处
《医学信息》
2022年第20期24-31,共8页
Journal of Medical Information
基金
广西科技厅自然科学资金面上项目(编号:2017GXNSFAA198143)。
关键词
难治性高血压病
中医药辨证治疗
肱踝脉搏波传导速度
颈动脉内膜
Refractory hypertension
Chinese medicine dialectical treatment
Brachial ankle pulse wave velocity
Carotid intima
