Randomized Controlled Trials On The Treatment Of Point Application For Chronic Stable Angina Pectoris:a Meta-analysis And Clinical Trail

Objective:To assess the curative effect and safety of acupoint application treating chronic stable angina pectoris basing on the systemtic review and clinical randomized controlled trial, providing a reference for clinical studies.Methods:1. With the method of cochrane’s systematic review,5 databases were searched, including Pubmed, Wanfang, CBM, CNKI, VIP, between 1990 and 2013. According to the inclusion and excluding criteria, the up-to-standard randomized controlled trials of acupoint application for stable angina were included. Rev Man 5.3 was used to analysis the outcomes.2. This clinical study is a randomized, double-blind, placebo-controlled trial.All of 60 patients were randomized according to random codes produced by SAS 9.1 into 2 groups:a herbal medicine application on acupoints, placebo application on acupionts group.Two groups used common points:Jueyinshu, Xinshu, Danzhong, Neiguan and underwent the same basic treatment procedure. All participants received 12 sessions of treatment in 4 weeks and 4-week treatment phase, and 4-week follow-up phase. The efficacy outcomes indexes, including the change of the total frequency of self-reported angina attacks, the VAS score, the SAQ score, incidence of cardiovascular events, were measured.Results:1. Results of systematic review:There were statistical differences between the point application group and drug therapy group in relieving angina symptoms (95%CI =1.07～1.20, RR=1.13, P=0.000). There were statistical differences between point application group and western medicine therapy group in ECG effect (95%CI =1.04～1.20, RR=1.12, P=0.002). There were statistical differences in traditional Chinese medicine (TCM) symptoms between point application group and drugs therapy group (95%CI=1.05～1.25, RR=1.14, P=0.004). We used sensitivity analysis to decrease the significant heterogeneity in trials (I2=89%), comparing acupoint application group with drugs group in reliving the overall effect, and there were statistical differences after sensitivity analysis (95% CI=1.16～1.64, RR=1.38, P=0.0003). In addition, the trials reported adverse reactions were analyzed by fixed effects model, and there were statistical differences (95%CI=1.23～24.51, RR=5.50, P=0.03).2. Results of clinical trials:The two groups’ baselines were comparable. The efficacy of group A was better than group B in angina attacks、the VAS score、the SAQ score (four dimensionality:anginal stability、anginal frequency、treatment satisfaction、 disease perception) (P<0.05). In group A, angina frequency、the VAS score、the SAQ score were much better at the 4th and 8th week compared with week0 (P< 0.05).There were 2 patients had mild adverse reactions with no treatment, no affection of curing in group A. There were no cardiovascular events throughout the study.Conclusion:1.Acupoint application treatment for angina patients make the angina frequency, ECG, traditional Chinese medicine symptoms and overall effect improve, meanwhile, the safety of acupoint application combined with drug must be increased.2. The curative effect of acupoint application with traditional Chinese medicine group in angina frequency, pain severity, Seattle angina scores is better than placebo group, meanwhile, no serious adverse events and cardiovascular events come up throughout the study.