尹秀平　谢雁鸣　廖星　罗曼

[摘要] 该研究旨在对中药注射液治疗冠心病的系统评价进行再评价。计算机检索中英文数据库，查找中药注射液治疗冠心病的系统评价，制定纳排标准和数据提取表，采用 AMSTAR量表、PRIMSA声明对纳入文献进行方法学质量评价和报告质量评价。最终纳入69个系统评价，涉及24种中药注射剂，其治疗冠心病有一定疗效，主要结局指标有改善心绞痛症状和心电图改善等，所纳入系统评价均未报告结局指标随访时间，6个系统评价报道了中药注射剂治疗冠心病的中医证型，44个系统评价中有1 335个研究提及4 137例发生了不良反应。对纳入研究进行质量评价的评分不高，大部分系统评价存在异质性资料和森林图标识处理不合理问题。治疗冠心病的中药注射剂种类广泛且具有一定疗效，但由于系统评价质量偏低和系统评价再评价制作过程影响，该研究存在一定局限性，因此，所获得的支持证据强度有待进一步提升，以期为临床医生提供更高级的临床证据。

[关键词] 冠心病；中药注射液；系统评价；循证医学

Reevaluation for systematic reviews for traditional Chinese

medicine injections for coronary disease

YIN Xiuping2， XIE Yanming1， LIAO Xing1*， LUO Man3

（1. Institute of Basic Research in Clinical Medicine， China Academy of Chinese Medical Sciences， Beijing 100700， China；

2. Guang′anmen Hospital， China Academy of Chinese Medical Sciences， Beijing 100053， China；

3. Institute of Acupuncture and Moxibustion， China Academy of Chinese Medical Sciences， Beijing 100700， China）

[Abstract] To reevaluate the systematic reviews for traditional Chinese medicine（TCM） injections for treating coronary disease， data in four Chinese databases and PubMed， Embase， Cochrane Library， Wed of Science OVID from inception until May 2016 were searched. We extracted data according to the AMSTAR and PRISMA checklists to evaluate the methodological quality and reporting characteristics of included literatures. A total of 69 systematic reviews were included， involving 24 TCM injections， which showed certain efficacy in treating coronary disease， and whose main outcome indexes included alleviation of symptoms of angina pectoris and electrocardiogram. In all of the systematic reviews， the duration of followup were not reported. Six systematic reviews reported TCM typing. In the 44 system reviews， 1 335 reports mentioned 4 137 adverse events. According to the results of AMSTAR and PRISMA checklists， the quality assessment scores about included studies were not high， and most of the systematic reviews suffered heterogeneity and irrational processing of forest plots. In conclusion， TCM injections in the treatment of coronary disease have a wide range and positive effects. However， affected by the low quality of systematic reviews and the production of reevaluation， the study had some limitations. Therefore， the systematic reviews shall be further improved， in order to provide more advanced clinical evidences to clinicians.

[Key words] coronary disease； injection； systematic reviews； evidence based medicine

doi：10.4268/cjcmm20162228

冠心病是由于冠状动脉发生粥样硬化或痉挛导致心肌缺血、缺氧或心肌坏死的心脏病，我国冠心病的发病率和病死率随着人民生活水平的提高、生活方式和膳食结构的改变，呈逐年上升趋势，且发病日趋年轻化，现已跃居导致人口死亡的主要原因之列[12]。在我国用中药预防和治疗疾病已经有几千年的历史，与西药相比，这些天然药物具有作用温和、安全性高等特点。……