王昀 贾元萍 邱新萍

摘要 目的：系統评价柴胡加龙骨牡蛎汤治疗冠心病心绞痛合并焦虑抑郁的有效性和安全性。方法：检索国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science、The Cochrane library和临床试验注册中心（ChiCTR、Clinic Trials），筛选符合纳入标准的随机对照试验（RCT），检索时间为建库之日至2020年4月30日。采用Cochrane干预措施系统评价手册进行文献方法学质量评价，通过RevMan 5.3软件进行数据分析。结果：共纳入11篇RCT文献，总病例数760例。Meta分析结果示：与对照组比较，柴胡加龙骨牡蛎汤能提高心绞痛有效率（RR=1.27，95%CI为1.18～1.37）、中医证候有效率（RR=1.44，95%CI为1.29～1.60）和焦虑有效率（RR=1.21，95%CI为1.03～1.42），能降低HAMD评分（MD=-3.54，95%CI为-4.94～-2.14）和心绞痛发病频率（MD=-2.30，95%CI为-2.79～-1.82），差异有统计学意义（P<0.05），且无证据表明有明显不良反应发生。根据GRADE标准，心绞痛有效率和中医证候有效率为低质量证据，焦虑有效率、HAMD评分和心绞痛发作频率为极低质量证据。结论：柴胡加龙骨牡蛎汤能改善冠心病心绞痛合并焦虑抑郁患者的临床症状，较西医基础治疗有明显优势，安全性良好，但仍需高质量文献证据支持。

关键词 柴胡加龙骨牡蛎汤;冠心病心绞痛;焦虑;抑郁;系统评价

Chaihu Longgu Muli Decoction in the Treatment of Angina Pectoris Combined with Psychological Disorder，a Systematic Review

WANG Yun1，JIA Yuanping2，QIU Xinping1

（1 Shunyi Hospital，Beijing Traditional Chinese Medicine Hospital，Beijing 101300，China; 2 Beijing University of Chinese Medicine，Beijing 100029，China）

Abstract Objective：To systematically evaluate the efficacy and safety of Chaihu Longgu Muli Decoction in the treatment of angina pectoris with anxiety and/or depression.Methods：Domestic and foreign databases [National Knowledge Infrastructure Database（CNKI）; China Academic Journal Database（CSPD）; Chinese Science and Technology Journal Database（CCD），CBM，PubMed，Embase，Web of Science，The Cochrane library] and Clinical Trial Registry（ChiCTR，Clinic Trials）were searched，to screen randomized controlled trials（RCT）that met the inclusion criteria，and the search time was from the date of establishment of the database to April 30，2020.The Cochrane Intervention System Evaluation Manual was used to evaluate the methodological quality of the literature，and the RevMan 5.3 software was used to analyze the data.Results：A total of 11 RCT literature were included，with a total of 760 cases.The results of Meta analysis showed that：compared with the control group，Chaihu Longgu Muli Decoction could improve the efficiency of angina pectoris [relative risk（RR）=1.27，95% confidence interval（CI）1.18 to 1.37]，the efficiency of TCM syndrome（RR=1.44，95%CI 1.29 to 1.60），and the efficiency of anxiety（RR=1.21，95%CI（1.03 to 1.42），reduce the HAMD score [mean difference（MD）=-3.54，95%CI-4.94 to -2.14]，and the incidence of angina（MD=-2.30，95%CI-2.79 to -1.82），the difference was statistically significant（P<0.05），and there were no significant evidence of adverse reactions.According to GRADE standard，the effective rate of angina pectoris and the effective rate of TCM syndrome was low quality evidence，and the effective rate of anxiety，HAMD score，and the frequency of angina pectoris attack were extremely low quality evidence.Conclusion：Chaihu Longgu Muli Decoction could improve the clinical symptoms of patients in the treatment of angina pectoris with anxiety and/or depression.It has obvious advantages and good safety compared with the basic treatment of western medicine.But the high quality documentary evidence is still needed.

Keywords Chaihu Longgu Muli decoction; Angina pectoris; Anxiety; Depression; Systematic review

中图分类号：R289.5;R541文獻标识码：Adoi：10.3969/j.issn.1673-7202.2021.09.017

心血管疾病（Cardiovascular Disease，CVD）和精神心理障碍是世界上2个主要的健康问题。CVD是全球死亡的主要原因，每年约16.70万人死亡，其中冠状动脉疾病每年37万多人死亡，约73.5万人心脏病发作[1]。心绞痛是暂时性心肌缺血引起的胸部不适，可出现劳力性呼吸急促、恶心、出汗、乏力等症状，是冠心病的常见表现[2]。焦虑、抑郁是一种心理医学疾病，会产生多种认知、情感和身体症状，具有复发和慢性病的特征[3]，已被证实为冠心病的始动因素和加重的重要因素[4]，二者之间存在密切关系[5]。冠心病合并焦虑抑郁的发病率高、识别率和治疗率低，预后较差[6]，临床治疗主要通过冠脉手术和服用抗精神类药物[7]，并给予积极的心理疏导[8]。……