世界中医药

目的：系统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。

English Summary:

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.

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