Network Meta-Analysis of Chinese Patent Medicines in the Treatment of Cardiorenal Syndrome

目的：通过网状Meta分析(NMA)探讨中成药治疗心肾综合征的疗效和安全性。方法：检索多数据库(CNKI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library, Embase)中2024年6月30日前的中成药治疗心肾综合征的随机对照试验(RCTs)。用Cochrane偏倚风险评估工具评估研究质量，用Stata16软件进行网状Meta分析。结果：共纳入39项RCTs，涉及9种中成药，共计3377例患者。网状meta分析结果显示，在改善NT-proBNP方面，前三名分别是：苈强心胶囊 > 参麦注射液 > 肾康注射液；在改善LVEF方面，前三名分别是：银杏叶滴丸 > 丹红注射液 > 心脉隆注射液；在改善Scr方面，前三名分别是：百令胶囊 > 黄芪注射液 > 银杏叶滴丸；在改善CysC方面，前三名分别是：银杏叶滴丸 > 芪苈强心胶囊 > 心脉隆注射液；在改善IL-6方面，前三名分别是：丹红注射液 > 心脉隆注射液 > 参附注射液。结论：中成药联合常规西医治疗心肾综合征较常规西医治疗更能提高治疗效果，临床治疗实践中应根据患者具体症状实施个性化用药。未来研究需要更多多中心、大样本、高质量、进行中医辩证分型、对心肾综合征进行分类的RCTs来进一步验证。Objective: To investigate the efficacy and safety of Chinese patent medicines in the treatment of cardiorenal syndrome (CRS) by network meta-analysis (NMA). Methods: Multi-databases (CNKI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library, Embase) were searched for randomized controlled trials (RCTs) on Chinese patent medicines for cardiorenal syndrome before June 30, 2024. The Cochrane Collaboration’s tool for assessing the risk of bias was used to assess the quality of the studies. Stata16 software was used for network meta-analysis. Results: A total of 39 RCTs involving 9 kinds of Chinese patent medicines and 3377 patients were included. The results of network Meta-analysis showed that the top three in improving NT-proBNP were: Liqiangxin capsule > Shenmai injection > Shenkang injection; In terms of improving LVEF, the top three were: Ginkgo biloba dropping pill > Danhong injection > Xinmailong injection; In terms of Scr improvement, the top three were Bailing capsule > Astragalus injection > Ginkgo biloba dropping pills; In terms of improving CysC, the top three were: Ginkgo biloba dropping pills > Qili Qiangxin capsules > Xinmailong injection; In terms of improving IL-6, the top three were: Danhong injection > Xinmailong injection > Shenfu injection. Conclusion: Chinese patent medicine combined with conventional western medicine can improve the therapeutic effect of cardiorenal syndrome compared with conventional western medicine. Individualized medication should be implemented according to the specific symptoms of patients in clinical treatment practice. More multicenter, large-sample, high-quality RCTs with TCM dialectical classification and cardiorenal syndrome classification are needed for further verification in the future.