Objective To assess the effect of Dengzhanhua Injection for angina pectoris. Methods We performed an electronic search for MEDLINE (1966 to 2004), EMBASE (1974 to 2004), The Cochrane Library (Issue 4, 2004), CBM and CNKI (1980 to 2004). We included randomized controlled trials that met the inclusion and exclusion criteria and evaluated the quality of those trials and performed the meta-analysis by RevMan 4.2.7. Results Eight trials were included involving 634 patients. However, they were of poor quality. The results of meta-analysis indicated that there were statistical difference on symptoms and electrocardiogram (ECG) improvements between Dengzhanhua and control group (Breviscarpine≥30 mg) with RR 1.26, 95%CI 1.11 to 1.44 and RR 1.30, 95%CI 1.14 to 1.49, respectively. However, Dengzhanhua Injection (Breviscarpinelt;30 mg) vs. basic therapy showed no statistical difference in either symptom improvement (RR 1.03, 95%CI was 0.90 to 1.18) or ECG improvement (RR 1.01, 95%CI 0.86 to 1.20). In addition, Dengzhanhua decreased the myocardial infarction attacks in one year following up (OR 0.06, 95%CI 0.01 to 0.29). Conclusions Little evidence shows that Dengzhanhua is superior to simple basic therapy in the symptoms and ECG improvements as an auxiliary drug. However, this systematic review can not draw a conclusion about the effectiveness of Dengzhanhua Injection compared to simple basic therapy in the treatment of angina pectoris due to the poor quantity of included trials.
目的:探讨并研究纤溶系统与纤维蛋白原在不稳定型心绞痛(UA)患者发病中的临床价值。方法:对108例不稳定型心绞痛患者和42稳定型心绞痛(SA)患者体内纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活剂(t-PA)、纤维蛋白原(FIB)水平进行检测,并与20例正常对照者进行对照,探讨其临床意义。结果:UA患者体内PAI-1、FIB水平明显高于SA患者和正常对照者,UA患者中有心血管事件发生者也明显高于无心血管事件发生者;UA患者体内t-PA水平明显低于SA患者和正常对照者,UA患者中有心血管事件发生者也明显低于无心血管事件发生者。结论:UA 患者纤溶系统功能异常和FIB水平升高程度较SA患者更加明显,并且UA患者的心血管事件发生可能与溶系统功能异常和FIB水平升高相关。
【摘要】 目的 评价葛根素注射液（PI）联合低分子肝素（LMWH）治疗不稳定型心绞痛（UAP）的疗效和安全性。 方法 计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊全文数据库（VIP-维普）、万方-数字化期刊全文库，纳入在常规治疗上加用PI和LMWH对比单纯常规治疗的随机对照试验（RCT），对纳入研究进行质量评价和Meta分析。 结果 共纳入21个RCT，均为C级文献。Meta分析结果显示，在临床症状疗效显效率、心电图疗效显效率和有效率指标方面，两组差异有统计学意义:RR（95%CI）分别为:1.63（1.48，1.79）、1.57（1.34，1.83）及1.28（1.10，1.49）。 结论 基于上述证据，在常规治疗UAP上加用PI和LMWH疗效优于常规治疗。【Abstract】 Objective To evaluate the effect of the puerarin injection (PI) combined with low molecular weight heparins (LMWH) on unstable angina pectoris (UAP). Methods Randomized controlled trials (RCT) of PI combined with LMWH treating UAP were gathered from CBM, CNKI, VIP, and Wanfang data bases; and study quality was evaluated and the Meta-analysis was carried out. Results A total of 21 RCT were identified, of which all were in graded C. According to Meta-analysis, the differences of the clinic excellent rate, electrocardiogram excellent rate and effective rate between the two groups were significant; the RR (95%CI) were: 1.63 (1.48, 1.79), 1.57 (1.34, 1.83), and 1.28 (1.10, 1.49). Conclusion Based on the evidence recently, PI and LMWH adding is better than ordinary treatment for UAP.
ObjectiveTo analyze the influence factors of the stable angina pectoris patients' medication compliance based on health belief model. MethodsFrom January to December, 2013, 107 patients with stable angina pectoris were interviewed using the self-design questionnaires, and multiple stepwise linear regression statistical was used to analyze. ResultsThe influence factors of increasing medication compliance were as follows:"myocardial infarction can lead to death", "patients with stable angina pectoris may suffer a sudden myocardial infarction", "over the past year the number of the angina pectoris", "standard treatment is good for prevention of myocardial infarction", "suffering myocardial infarction, even if not dying, there is no more chance to live", "take medicine on time can get family's praise", and "among the people that I know there are patients who die of myocardial infarction". The partial regression coefficients were 0.245, 0.251, 0.248, 0.099, 0.234, 0.162, 0.095, respectively; while "worry about side effects of the drugs", "can't afford the medicine", the partial regression coefficients were -0.164 and -0.114. ConclusionHealth belief model is helpful for general practitioners to evaluate the effect factors of medication compliance on stable angina pectoris.
Objective Danshen dripping pill (DSP) and tongxinluo capsule (TXL) are popular Chinese medicinal products and often compared with isosorbide dinitrate (ISDN) in treating angina pectoris. Hundreds of randomized controlled trials (RCTs) about DSP and TXL have been published; however, there has been no systematic review on comparing DSP with TXL. This study aims to provide a comprehensive PRISMA-compliant systematic review with sensitivity analysis and subgroup analysis to valuate indirectly the efficacies of DSP and TXL in treating angina pectoris. Methods RCTs published between 1994 and 2009 on DSP and TXL in treating angina pectoris for four or more weeks were retrieved from databases. The qualities of RCTs included were evaluated with Jadad scale. Meta-analysis was performed on overall effects of symptomatic and electrocardiographic (ECG) improvements. Odds ratios (OR) and 95% confidence intervals (95%CI) were used to measure the effect size. Subgroup analysis, sensitivity analysis and meta-regression were conducted on basic characteristics of RCTs. Results 65 RCTs with 6 969 participants were included. Average Jadad score was 2.11. Overall ORs were 3.66 (95%CI 2.67 to 5.02) for TXL versus ISDN and 2.38 (95%CI 1.90 to 2.99) for DSP versus ISDN. There was a significant difference (W=521.5, P=0.049 45) in ORs between DSP and TXL. Statistical analyses found no significant factors affecting overall efficacies of TXL and DSP. The rates of adverse events under DSP and TXL treatments were 2.37% and 2.11%, respectively. Conclusion DSP and TXL are more effective than ISDN in treating angina pectoris. TXL might be more effective than DSP. However, further RCTs of larger scale, multi-centre/country, longer follow-up periods and higher quality are still required to verify.
目的:观察低分子肝素钙联合舒血宁(银杏叶提取物)治疗不稳定型心绞痛疗效。方法:选择符合诊断标准的不稳定型心绞痛患者88例。随机分为治疗组与对照组,对照组给予常规药物治疗,治疗组在常规治疗的基础上给予低分子肝素钙和舒血宁注射液治疗。结果:2周结束后治疗组各项观察指标较对照组明显改善,两组差异明显(Plt;005)。结论:低分子肝素钙联合舒血宁治疗不稳定型心绞痛效果显著。
ObjectiveTo systematically review the effectiveness and safety of salvianolate injection and Danshen injection for patients with angina pectoris, and evaluate the cost of drug. MethodsWe electronically searched databases including PubMed, CENTRAL (Issue 4, 2013), CNKI, VIP and WanFang Data (2004.1 to 2013.5) for the randomized controlled trials (RCTs) on the comparison between salvianolate injection and Danshen injection for angina pectoris from January 2004 to May 2013. Relevant journals and conference proceedings were also manually retrieved. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria, extracted the data and assess the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 196 patients were included. The results of meta-analysis showed that, salvianolate injection was obviously superior to Danshen injection in the effectiveness (OR=3.79, 95%CI 2.78 to 5.17, P < 0.000 01) and safety (OR=0.24, 95%CI 0.09 to 0.64, P=0.004), but lack of economic advantages in the treatment of the angina pectoris diseases. ConclusionCurrent evidence indicates that, salvianolate injection is a safe and effective scheme for angina pectoris, and Danshen injection is considered as a economic method. Because of the limited quantity and quality of currently-available research, the aforementioned conclusion should be verified by strictly-designed and large-scale sample RCTs.
Objective To determine the benefits of an invasive compared to a conservative strategy for treating unstable anguba (UA)/ non-ST-elevation myocardial infarction (NSTEMI). Methods We searched The Cochrane Library (Issue 4, 2009), MEDLINE (1996 to September 2009), EMbase (1974 to September 2009), CBM (1989 to 2009), CNKI (1997 to 2009), and VIP (1989 to 2009). The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials involving 11 394 patients met the inclusion criteria. The results meta-analyses showed the incidence of all-cause mortality at six months follow-up was lower in the early invasive group compared with the conservative group (RR=0.75, 95%CI 0.61 to 0.92, P=0.007); the relative risk of myocardial infarction was significantly decreased in the early invasive group (RR=0.74, 95%CI 0.63 to 0.87); there was a reduction in rehospitalization for unstable angina in the invasive group (RR=0.66, 95%CI 0.61 to 0.73, Plt;0.000 01); the invasive strategy was associated with a two-fold increase in the relative risk of PCI-related myocardial infarction (as variably defined). There was not a significant increase in bleeding by an invasive strategy at six months follow-up, but, a routine invasive strategy was associated with a significantly higher bleeding rate at 1-year follow-up (RR=2.22, 95%CI 1.55 to 3.17, Plt;0.000 1). Patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in patients with negative baseline marker levels. Conclusion An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI, especially higher-risk patients with elevated cardiac biomarker benefit more from invasive strategy. In addition, complications such as procedure-MI and bleeding must be paid great attention to.
We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.