| Objective:This study will collect and collate the results of clinical researches on the treatment of coronary heart disease with traditional Chinese medicine combined with western medicine in recent years and systematically evaluate its curative effect.At the same time using data mining technology on the use of Chinese medicine decoction composition or composition of Chinese medicine for drug analysis.With a view to provide theoretical basis for future clinical treatment of coronary heart disease after stent.Methods:Pub Med,EMBASE,Cochrane library,Chinese biomedical literature database(CBM),Chinese journal full text database(CNKI),Wanfang database and Chinese full-text database of science and Technology(VIP)were retrieved by computer from their building to December 31,2017.Manual retrieval AHA cardiovascular annual meeting,ACC cardiovascular annual meeting,ESC cardiovascular annual meeting and Chinese interventional cardiology conference,Chinese Heart Disease Conference papers to get the clinical research results of Chinese medicine treatment of coronary heart disease patients after stent implantation.RCTs will be analysed by using Review Manager 5.3 software.While analyzing the rules of drug use,we used Excel 2010 software to describe the frequency of the use of single drugs,and used the Apriori model of IBM modeler 14.1 to mine association rules of drug combinations.Results:In the study of Meta analysis,94 studies were finally included,involving a total of 8439 cases.In the treatment group,4244 cases were treated with traditional Chinese medicine and conventional western medicine,while 4195 cases in the control group were treated with simple conventional western medicine.For traditional Chinese medicine interventions,45 studies used herbal decocting decoction,6 studies used Chinese traditional medicine injection,and 43 studies were oral Chinese patent medicine(granule,tablet or capsule).The study included 20 articles of high quality,with Jadad scoring 3-4 points.The remaining 70 were low-quality articles and Jadad scored 1-2 points.The results of meta analysis are as follows:1In the evaluation of the curative effect of Chinese Medicine(1)The total score of TCM syndrome in the test group was better than that of the control group after treatment(MD=-2.4,95%CI=[-2.45,-2.34],effect test Z=82.31,P < 0.01).(2)The score of blood stasis syndrome in the experimental group was better than that of the control group after treatment(MD=-4.84,95%CI=[-6.89,-2.78],effect test Z=4.61,P < 0.01).(3)The score of qi deficiency syndrome in the experimental group was better than that of the control group after treatment(MD=-8.90,95%CI=[-9.98,-7.83],effect test Z=16.24,P < 0.01).(4)The score of chest distress in the test group was better than that of the control groupafter treatment(MD=-0.48,95%CI=[-0.57,-0.39],effect test Z=10.27,P < 0.01).(5)The score of chest pain in the test group was better than that of the control group after treatment(MD=-0.45,95%CI=[-0.71,-0.19],effect test Z=3.44,P < 0.01).(6)The symptom score of palpitation in the test group was better than that of the control group after treatment(MD=-0.54,95%CI=[-0.90,-0.38],effect test Z=4.81,P < 0.01).(7)The efficiency of TCM syndrome in the experimental group was better than that of the control group after treatment(OR=1.19,95%CI=[1.00,1.42],effect test Z=1.96,P=0.05).(8)The efficacy of TCM syndrome in the experimental group was better than that of the control group after treatment(OR=0.21,95%CI=[0.17,0.27],effect test Z=12.63,P < 0.01).2 In the clinical evaluation of Western medicine:(1)The physical activity restricted score in the experimental group was better than that of the control group after treatment(MD=3.82,95%CI=[0.08,7.57],effect test Z=2,P=0.05).(2)The angina pectoris stability score in the experimental group was better than that of the control group after treatment(MD=0.99,95%CI=[0.10,1.88],effect test Z=2.19,P< 0.05).(3)The angina pectoris attack score in the experimental group was better than that of the control group after treatment(MD=2.49,95%CI=[0.70,4.28],effect test Z=2.72,P<0.05).(4)The treatment satisfaction score in the experimental group was better than that of the control group after treatment(MD=4.82,95%CI=[1.56,8.09],effect test Z=2.89,P < 0.05).(5)There was no difference between the experimental group and the control group in the score of cognitive degree of disease after treatment(MD=0.99,95%CI=[0.10,1.88],effect test Z=2.19,P>0.05).(6)There was no difference between the experimental group and the control group in the efficiency of electrocardiogram after treatment(OR=1.05,95%CI=[0.85,1.30],effect test Z=0.49,P>0.05).(7)The inefficiency of electrocardiogram in the experimental group was lower than that of the control group after treatment(OR=0.39,95%CI=[0.29,0.51],effect test Z=6.74,P < 0.05).(8)There was no difference between the experimental group and the control group in the efficiency of angina pectoris after treatment(OR=1.08,95%CI=[0.85,1.39],effect test Z=0.63,P > 0.05).(9)The inefficiency of angina pectoris in the experimental group was lower than that of the control group after treatment(OR=0.26,95%CI=[0.19,0.37],effect test Z=7.71,P < 0.05).3 In terms of blood lipids,glucose metabolism related indicators:(1)TC in the experimental group was lower than that of the control group after treatment(MD=-0.47,95%CI=[-0.74,-0.20],effect test Z=3.42,P=0.05).(2)TG in the experimental group was lower than that of the control group after treatment(MD=-0.24,95%CI=[-0.36,-0.12],effect test Z=4.02,P<0.05).(3)HDL-C in the experimental group was higher than that of the control group after treatment(MD=0.12,95%CI=[0.01,0.23],effect test Z=2.06,P<0.05).(4)LDL-C in the experimental group was lower than that of the control group after treatment(MD=-0.24,95%CI=[-0.36,-0.13],effect test Z=4.04,P<0.05).4 In terms of inflammatory factors related indicators:(1)Hs-CRP in the experimental group was lower than that of the control group after treatment(SMD=-1.51,95%CI=[-2.14,-0.89],effect test Z=4.76,P<0.05).5 In terms of cardiac structure and function related indicators:(1)LVEF in the experimental group was higher than that of the control group after treatment(MD=5.20,95%CI=[2.29,8.11],effect test Z=3.50,P=0.05).6 In the end of the cardiovascular event:(1)The stent restenosis rate in the experimental group was lower than that of the control group after treatment(OR=0.31 95%CI=[0.24,0.40],effect test Z=9.17,P<0.05).(2)The incidence of myocardial infarction in the experimental group was lower than that of the control group after treatment(OR=0.23,95%CI=[0.09,0.58],effect test Z=3.12,P < 0.05).(3)There was no difference between the experimental group and the control group in the rate of Cardiogenic death after treatment(OR=0.40,95%CI=[0.11,1.39],effect test Z=1.45,P > 0.05).(4)There was no difference between the experimental group and the control group in the rate of CABG after treatment(OR=0.54,95%CI=[0.27,1.09],effect test Z=1.73,P > 0.05).Whlie in the study of drug rule analysis,99 prescriptions were included,48 of which were decoction,1 Chinese medicine injection and 49 oral Chinese medicine.There are 121 kinds of traditional Chinese medicine,using 795 frequency.There were 22 kinds of drugs with frequency of more than 10%.However,activating blood and removing stasis medicine was the largest,and the top three were danshen,chuanxiong and safflower.In the combination of two drugs,sanqi and danshen come first.While yu jin and chuanxiong and danshen ranked first in the combination of three drugs,trichosanthes and chuanxiong,astragalus,and danshen rank first in the combination of four drugs,Peach kernel and angelica,Radix paeoniae rubra,Chuanxiong,and allium macrostemon are the first in the combination of five drugs.Conclusions:(1)Combine traditional Chinese and western medicine treatment after coronary stent implantation can improve clinical symptoms,blood fat and hs-CRP in serum inflammatory factor levels,improve the left ventricular ejection fraction,reduce stent restenosis and the incidence rate of nonfatal myocardial infarction,the difference had statistical significance(P < 0.05).About the integrals of cognitive degree of disease,the effective rate of ecg and angina,the rate of Cardiogenic death and CABG,the experimental group compared with the control group there was no significant difference.In some aspects,the meta results suggest that TCM has the advantage of improving the relevant pathological factors and reducing the occurrence of related cardiovascular adverse events in multi-target and multi-links.(2)Traditional Chinese medicine combined with western medicine in the treatment after PCI,the most commonly used traditional Chinese medicine is invigorating blood circulation,invigorating qi and invigorating qi.However,danshen,radix astragali and chuanxiong are often used in combination therapy with other drugs.It is consistent with the etiology and pathogenesis of traditional Chinese medicine after coronary artery stent implantation. |
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