Clinical Evaluation Of Ginkgo Injection Based On Bayesian Mesh Meta-analysis

BackgroundA large number of studies show that GIs has good therapeutic effect in the treatment of cardio-cerebrovascular diseases.However,clinicians still have difficulty in choosing the best treatment when they face a variety of injections.Therefore,this study adopts classical meta-analysis and Bayesian network meta-analysis method to systematically evaluate the efficacy and safety of GIs in the treatment of different diseases in order to provide reference for rational use of drugs in clinic.ObjectiveTo evaluate the efficacy and safety of GIs with classical meta-analysis and Bayesian network meta-analysis.MethodSearched systematically randomized controlled clinical trial(RCTs)of GIs from the databases of Embase,PubMed,the Cochrane Library,SinoMed,the China National Knowledge Infrastructure Database(CNKI),the Chinese Scientific Journals Database(VIP),and Wanfang Database.At the same time,the relevant grey literature website was searched as supplement.Adopt the risk evaluation form recommended by Cochrane Reviewer's Handbook was adopted.5.1.0 to evaluate the quality of RCTs.The data of classical meta-analysis are processed through Review Manager Software 5.3.The result of Bayesian Network meta-analysis was carried out using WinBUGS 1.4.3(MRC Bio-statistics Unit,Cambridge,UK)and STATA version 13.1(Stata Corp,College Station,TX).ResultsThe clinical evaluation of GIs in treatment of cerebral infarction(CI)includes 95 studies and a total of 10107 cases of subjects.The results of classic meta-analysis showed that Shuxuening Injection(SXN),Ginkgo Leaf Extract and Dipyridamole Injection(GD),Extract of Ginkgo Biloba Leaves Injection(EGb)can improve the total clinical efficiency and improve the degree of neurologic impairment score as adjuvant treatment of CI;Secondly,EGb plus CT can improve the plasma viscosity.The results of network meta-analysis showed that in a variety of interventions,Ginkgolide injection(GK)plus CT is optimal in terms of clinical total effective rate and neural function defect score index.The clinical evaluation of GIs in treatment of coronary heart disease(CHD)includes 62 studies and a total of 6358 cases of subjects.The results of classic meta-analysis showed that SXN,GD,EGb can improve the total clinical efficiency,electrocardiogram and hemorheology index as adjuvant treatment of CHD;Secondly,SXN plus CT can improve the blood lipids.The results of network meta-analysis showed that in terms of clinical total effective rate of angina pectoris,plasma viscosity and whole blood viscosity,GD plus CT is optimal.In terms of the electrocardiogram total effective rate and fibrinogen,the optimal interventions are respectively Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection(FT)and EGb.In the aspect of high sensitivity C-reactive protein and low density lipoprotein,SXN plus CT is the optimal intervention.The clinical evaluation of GIs in treatment of vertebrobasilar insufficiency(VBI)includes 47 studies and a total of 4122 cases of subjects.The results of network meta-analysis,which use CT as the control groups showed that in terms of clinical total effective rate,CT plus GD is optimal intervention.In terms of the 4 outcomes of the head TCD examination and the blood low viscosity,the optimal curative treatment is EGb plus CT.the other three outcomes of hemorheology the optimal curative treatment is SXN plus CT.The results of network meta-analysis,which use Compound Danshen Injection(CDS)or Danshen Injection(DS)as the control groups showed that in terms of total clinical effective rate and the blood flow velocity of basilar artery,the optimal curative treatment is EGb plus CT.In terms of the other 2 outcomes of the head TCD examination,the optimal curative treatment is FT plus CT.The clinical evaluation of GD in treatment of diabetic nephropathy(DN)includes 30 studies and a total of 2045 cases of subjects.The results of meta-analysis showed that in terms of the renal function index,hemorheology index,blood lipid index and blood sugar index,GD plus CT has good therapeutic effect and better than those in control groups.The clinical evaluation of GD in treatment of sudden hearing loss(SHL)includes 13 studies and a total of 1274 cases of subjects.The results of classical meta-analysis showed that in terms of the clinical total effective rate and total effective rate of tinnitus,GD plus CT has good therapeutic effect and better than those in control groups.ConclusionIn terms of the main outcomes of clinical total effective rate,GK plus CT has tremendous advantages than the other intervention in treatment of CI,GD plus CT has tremendous advantages than the others in treatment of CHD.In the study of VBI,the optimal treatment measures were GD and EGb respectively.