| Objective: In order to promote the transformation and application of clinical research evidence,this study summarizes and evaluates the randomized controlled trials of Chinese patent medicine in the treatment of coronary heart disease and angina pectoris from 2016 to2020,and puts forward reasonable suggestions.Meta-analysis and network Meta-analysis were used to evaluate and analyze the efficacy and safety of Chinese patent medicine in the treatment of coronary heart disease angina pectoris,providing evidence support and assisting clinical decision-making.Methods: 1.Based on the relevant literature collected by the Evidence-Based Research Evidence Database System(EVDS)of traditional Chinese medicine,and systematically searched databases such as CNKI,VIP,CBM,Wanfang Data Knowledge Service Platform,Pub Med,Web of Science,etc.,and included the data from 2016 to 2020 RCT of Chinese patent medicine in the treatment of coronary heart disease angina pectoris.2.Perform bibliometric analysis on the included literature and sort out basic information such as PICO.Methodological quality was assessed using the Cochrane Risk of Bias Tool.3.Using Rev Man5.4.0 for different angina pectoris types,carry out a Meta-analysis of the top three published studies on Chinese patent medicines for coronary heart disease angina pectoris.4.Using stata and winbugs software,a network Meta-analysis was carried out on the study of various Chinese medicine injections and oral Chinese patent medicines in the treatment of coronary heart disease and angina pectoris.Results: A total of 815 articles were included,including 811 in Chinese and 4 in English.The sample size of 57.92% of the studies was less than 100 cases.In terms of disease types,There were 293(35.95%)cases of unstable angina pectoris,112(13.74%)cases of stable angina pectoris,and 75(9.20%)cases of both stable angina pectoris and unstable angina pectoris were included in the report.There were 335(41.11%)cases without classification of angina pectoris.Involving 125 kinds of Chinese patent medicines(36 kinds of Chinese medicine injections,89 kinds of oral Chinese medicines).Shexiang Baoxin Pills,Tongxinluo Capsules,Compound Danshen Dropping Pills and other Chinese patent medicines have more than 100 studies.The longest reported course of treatment was 2 years and the shortest was 10minutes;it was concentrated in the 1-2 week interval(25.77%).The top three outcome indicators were clinical efficacy(total effective rate),the number of angina pectoris attacks,and electrocardiographic efficacy.In terms of methodology,58.28% of the studies had unclear randomization method description or application errors;the low risk rates of items such as allocation concealment,blinding of subjects and investigators,and other biases were all less than 5%.In addition,ethical review and program registration issues are still prominent.The results of Meta-analysis showed that in terms of the treatment effect of the core outcome indicators,Chinese patent medicine combined with conventional treatment was better than conventional treatment in improving clinical efficacy(total effective rate),angina symptoms,electrocardiographic efficacy,and reducing the incidence of cardiovascular events,and the results were stable.,the difference was statistically significant;the overall curative effect of angina attack times and angina attack time was better than that of the control group,but the heterogeneity was high,and the results were unstable.A network meta-analysis was conducted on 14 kinds of Chinese patent medicines,and the results showed that Danshen injections had better relative efficacy among multiple outcome indicators;Tongxinluo capsules were ranked in terms of clinical efficacy(total effective rate)and angina pectoris symptom improvement efficacy.Better;Shexiang Baoxin Pills ranked better in terms of the number of angina pectoris attacks and the duration of angina pectoris attacks.Conclusion: A large number of RCTs have been published on the treatment of coronary heart disease angina pectoris by Chinese patent medicines.Meta-analysis and network Meta results show that Chinese patent medicines combined with conventional western medicine have obvious advantages in the treatment of coronary heart disease angina pectoris.In terms of clinical efficacy(total effective rate),efficacy in improving angina pectoris symptoms,efficacy in electrocardiogram,and reduction in the incidence of cardiovascular events,Chinese patent medicines such as Shexiang Baoxin Pill,Tongxinluo Capsule,Compound Danshen Dropping Pill,and Danhong Injection Combined with conventional western medicine treatment,the curative effect is better than conventional treatment.The results of network meta-analysis showed that Danshen injection had better relative efficacy among multiple outcome indicators;Tongxinluo Capsule was better in terms of clinical efficacy(total effective rate)and angina pectoris symptom improvement efficacy;Shexiang Baoxin Pill The ranking is better in terms of the number of angina attacks and the duration of angina attacks.However,due to the lack of literature on individual interventions or outcome indicators and the low methodological quality,the reliability of the overall research conclusions is affected.In the future,it is necessary to strengthen methodological training for researchers to promote the output of high-quality research data.For some Chinese patent medicines with low quality evidence,it is recommended to carry out more high-quality large-sample clinical trials based on methodological expert opinions to further verify their efficacy and provide a basis for scientific decision-making. |
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