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>益气温阳、活血利水法联合西药与常规西药治疗慢性心力衰竭临床疗效比较的 Meta 分析
益气温阳、活血利水法联合西药与常规西药治疗慢性心力衰竭临床疗效比较的 Meta 分析
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摘要
Objective To compare the clinical effects of TCM with Tonifying Qi,Warming Yang,Activating Blood Circulation to Promote Diuresis with those of conventional Western Medicine(WM)on chronic heart failure(CHF)to provide basis for clinical decision making. Methods This study used Cochrane systematic review method and retrieved Medline,China HowNet,Wanfang database,VIP periodical library,Chinese Biomedical Literature Database for randomized controlled trials (RCT)or quasi - randomized controlled trials of Tonifying Qi,Warming Yang,Activating Blood Circulation to Promote Diuresis in treatment of CHF. jadad Scale was used to evaluate the quality of the enrolled literatures,RevMan 5. 2 software was used to perform Meta analysis. The markedly effective rates,effective rates,ineffective rates,pre - and post - treatment levels of left ventricular ejection fraction( LVEF)between groups TCM and WM were compared. Results A total of 6 literatures were enrolled,including 751 patients,376 in TCM group,375 in WM group. By Meta analysis,there were significant difference in markedly efficiency and inefficiency between 2 groups〔OR = 2. 03,95% CI(1. 50,2. 73),P < 0. 01;OR = 0. 26,95% CI (0. 16,0. 40),P < 0. 01〕,there was not in efficiency〔 OR = 1. 05,95% CI(0. 78,1. 41),P = 0. 74〕. There was no difference in LVEF between 2 groups before CHF treatment〔WMD = - 0. 17,95% CI( - 1. 10,0. 77),P = 0. 72〕,there was after treatment〔WMD = 10. 87,95% CI(9. 44,12. 30),P < 0. 01〕. Conclusion TCM with Tonifying Qi,Warming Yang,Activating Blood Circulation to Promote Diuresis,effective in CHF treatment,can improve markedly effective rate and LVEF,reduce ineffective rate,which is worthy of promotion. But it still needs RCTs of multi - center,large sample size,long follow - ups.%目的：比较加入益气温阳、活血利水法的中医治疗与常规西药治疗慢性心力衰竭的临床疗效，为临床决策提供依据。方法采用 Cochrane 系统评价方法，计算机检索 Medline、中国知网、万方数据库、维普期刊库、中国生物医学文献数据库中加入益气温阳、活血利水法的中医治疗慢性心力衰竭的随机对照试验（RCT）或半随机对照试验，采用 jadad 评分量表评价纳入文献的质量，采用 RevMan 5.2软件进行 Meta 分析。比较加入益气温阳、活血利水法的中医治疗组（治疗组）与常规西药治疗组（对照组）的显效率、有效率、无效率及治疗前、后左室射血分数（LVEF）的水平。结果共6篇文献符合纳入标准，包括751例患者，其中治疗组376例、对照组375例。Meta 分析结果显示，治疗组与对照组显效率和无效率间差异有统计学意义〔OR ＝2.03，95％ CI（1.50，2.73），P ＜0.01；OR＝0.26，95％ CI（0.16，0.40），P ＜0.01〕，治疗组与对照组有效率间差异无统计学意义〔OR ＝1.05，95％ CI（0.78，1.41），P ＝0.74〕。治疗组与对照组充血性心力衰竭患者治疗前 LVEF 间差异无统计学意义〔WMD ＝-0.17，95％ CI （-1.10，0.77），P ＝0.72〕，治疗后差异有统计学意义〔WMD ＝10.87，95％ CI（9.44，12.30），P ＜0.01〕。结论根据目前的文献结果，加入益气温阳、活血利水法的中医治疗心力衰竭是有效的，能提高显效率和 LVEF，降低无效率，值得临床推广，但仍需多中心、大样本量、随访时间长的 RCT 以佐证。
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