| ObjectiveCardiovascular diseases include coronary atherosclerotic heart disease,myocardial disease,heart failure,pulmonary heart disease and so forth.Also,it is the leading cause of premature death worldwide.In China,the annual number of deaths due to cardiovascular diseases accounts for 40.27%of the total number of the deaths,while 20 out of every 100 people suffer from cardiovascular diseases.The impairment of cardiovascular disease has been a global public health issue with its high morbidity and mortality.Tonic Chinese herbal injection(CHIs)refers to the traditional CHIs containing tonic Chinese medicine,which has the effect of tonifying qi and preventing exhaustion,nourishing and removing pathogenic factors,nourishing yin and generating body fluid,mainly including huangqi injection,shenfu injection,shengmai injection,shenmai injection,shenqi fuzheng injection and so on.Tonic CHIs are widely used in cardiovascular diseases due to its remarkable efficacy.While the utilization of a conjunction between tonic CHIs and western medicine(WM)in its treatment,their efficacy has been promoted and many relevant randomized controlled trials(RCTs)have verified them.However,there is still a lack of clinical trials to compare the efficacy of tonic CHIs directly.As a tool of evidence-based medicine,the Bayesian network meta-analysis(NMA)could compare various interventions in the treatment of the outcomes,and also could rank their efficacy in different outcomes aimed at making full use of single RCT and comparing the efficacy of various tonic CHIs at the same time.Given that,this study incorporated tonic CHIs,namely Ciwujia injection(CWJI),Dazhuhongjingtan injection(DZHJTI),Huangqi injection(HQI),Shenfu injection(SFI),Shengmai injection(SI),Shenmai injection(SMI),Shenqi Fuzheng injection(SQFZI),and Yiqifumai injection(YQFMI)and so on,and evaluated the efficacy of these injections combined with WM using Bayesian NMA in the treatment of chronic heart failure,dilated cardiomyopathy,pulmonary heart disease,angina pectoris and acute myocardial infarction The goal of this study was to figure out the better intervention and provide comprehensive evidence for the selection of cardiovascular disease treatmentMethodsA literature search was performed in PubMed,Cochrane Library,EMBASE,Chinese Biological Medicine Database,China National Knowledge Infrastructure,Wanfang Database,and Chinese Scientific Journal Database.This study was conducted in accord with a priori eligibility criterion and methodological quality.Data analysis was calculated by WinBUGS 1.4.3 and Stata 13.0 software focusing on the clinical effectiveness rate,cardiac function,haemorheology index,serum lipid parameter,arterial blood gas analysis,six-minute walking test,adverse drug reactions/adverse drug events and so forth.In addition to the odds ratio or mean difference in various outcomes,the ranking probability of interventions calculated by the surface under the cumulative ranking area(SUCRA)curve was demonstrated.SUCRA was equal to the rank of the intervention and was aimed to assess the best intervention.According to SUCRA,the optimal intervention was obtained by cluster analysis.Also,Stata 13.0 software was used to draw network plot,funnel plot,network forest plot,contribution plot and so forth.Results1.The NMA results of tonic CHIs in the treatment of chronic heart failure113 RCTs including 9535 patients were included and six tonic CHIs(HQI,SFI,SI,SMI,SQFZI and YQFMI)were enrolled.This NMA focused on the clinical effectiveness rate,cardiac function indexs and six-minute walking test.The NMA results demonstrated that all eligible CHIs plus WM were superior to WM alone.Combined with cluster analysis,chronic heart failure patients received SMI,SI or SQFZI plus WM may be more efficacious.The combination of SMI and WM focused on improving the clinical effectiveness rate.SI plus WM has a significant effect on improving cardiac function and helping patients' recovery.SQFZI plus WM was a better intervention to improve the content of brain natriuretic peptide.2.The NMA results of tonic CHIs in the treatment of dilated cardiomyopathy40RCTs including 2970 patients were included and six tonic CHIs(HQI,SFI,SI,SMI,SQFZI and YQFMI)were enrolled.This NMA focused on the clinical effectiveness rate,left ventricular ejection fraction,left ventricular end diastolic diameter,heart rate,cardiac output and six-minute walking test.The NMA results demonstrated that all eligible CHIs plus WM were superior to WM alone.And SFI plus WM ranked the highest in the clinical effectiveness rate,left ventricular ejection fraction,heart rate and six-minute walking test,while SMI plus WM attained the first rank in lowing left ventricular end diastolic diameter and cardiac output.Combined with cluster analysis,SFI plus WM was efficacious than others in the treatment of dilated cardiomyopathy.3.The NMA results of tonic CHIs in the treatment of pulmonary heart disease118 RCTs including 10228 patients were included and seven tonic CHIs(CWJI,DZHJTI,HQI,SFI,SI,SMI and SQFZI)were enrolled.This NMA focused on the clinical effectiveness rate,arterial blood gas analysis,haemorheology indexes and right ventricular dimension.The NMA results demonstrated that all eligible Chinese herbal injections plus WM were superior to WM alone,particularly in promoting clinical effectiveness rate,improving respiratory failure and reducing pulmonary arterial hypertension.Combined with cluster analysis,SFI plus WM,SMI plus WM,and SQFZI plus WM exhibited outstanding efficacy compared with the others.4.The NMA results of tonic CHIs in the treatment of angina pectoris73RCTs including 10085 patients were included and eight tonic CHIs(CWJI,DZHJTI,HQI,SFI,SI,SMI,SQFZI and YQFMI)were enrolled.This NMA focused on symptomatic improvement,electrocardiography improvement,fibrinogen,triglyceride and cholesterol.The NMA results demonstrated that all eligible CHIs plus WM were superior to WM alone Combined with cluster analysis,SQFZI plus WM and SMI plus WM exhibited a better effect than others.Meanwhile,HQI plus WM and SQFZI plus WM exerted an outstanding impact on the haemorheology indexs and serum lipid parameter by reducing fibrinogen,triglyceride and cholesterol levels5.The NMA results of tonic CHIs in the treatment of acute myocardial infarction27RCTs including 2445 patients were included and six tonic CHIs(DZHJTI,HQI,SFI,SI,SMI and SQFZI)were enrolled.This NMA focused on the clinical effectiveness rate,the rate of venous thrombolysis and recanalization,chest pain relief occurance,reduction in ST-segment elevation occurance,advanced peak of myocardial enzyme occurance and reperfusion arrhythmia occurance.The NMA results demonstrated that all eligible CHIs plus WM were superior to WM alone.And HQI plus WM attained the first rank in the clinical effectiveness rate,and SI plus WM had better impact on the others.Combined with cluster analysis,HQI plus WM and SI plus WM was efficacious than others in the treatment of acute myocardial infarction.ConclusionsBased on the results of this study,tonic CHIs combined with WM did a good performance in the treatment of cardiovascular diseases.The NMA results suggested that ?SI,SMI and SQFZI combined with WM respectively possessed the obvious strengthen in improving the clinical efficacy of patients with chronic heart failure.?SFI combined with WM were noticeably better than others in the treatment of dilated cardiomyopathy.?SFI,SMI and SQFZI combined with WM were noticeably better than others in the treatment of pulmonary heart disease.?SQFZI and SMI combined with WM respectively had excellent performance in improvine the clinical efficacy of patients with angina pectoris.? HQI and SI combined with WM exhibited superior performance in improving the clinical efficacy of patients with acute myocardial infarction.Meanwhile,this study could not draw a specific conclusion regarding the safety of tonic CHIs due to insufficient information.Each tonic CHIs combined with WM has its own merits in the treatment of cardiovascular diseases.Clinical treatment should be selected according to the specific situation of patients and tonic CHIs... |
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