Evidence construction of traditional Chinese medicine injections for Group 3 pulmonary hypertension: A Bayesian network meta-analysis of 70 randomized controlled trials

IF 1.7 4区医学 Q3 INTEGRATIVE & COMPLEMENTARY MEDICINE

European Journal of Integrative Medicine Pub Date : 2025-03-24 DOI:10.1016/j.eujim.2025.102446

Zhaohui Ding , Xunxun Yuan , Junfeng Fan , Fangfang Chao , Jia Xiao , Huie Luo , Hanrong Xue , Lihua Wang

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Abstract

Introduction

Traditional Chinese medicine (TCM) injections have potential in treating primary conditions associated with Group 3 pulmonary hypertension (G3PH) and preventing its progression. However, the optimal intervention for specific outcomes remains unclear.

Methods

Randomized controlled trials (RCTs) were identified from eight databases up to December 26, 2024. The Risk of Bias 2 (RoB 2) tool was employed to evaluate the risk of bias of the included RCTs. Bayesian network meta-analyses were conducted to assess the effectiveness of TCM injections for G3PH. The effectiveness and safety of TCM injections were ranked based on the surface under the cumulative ranking curve (SUCRA).

Results

Seventy RCTs were included, involving 17 TCM injections and 6148 patients. According to the RoB 2 assessment, 65 and 5 RCTs were classified as having “some concerns” or “high” risk of bias, respectively. Bayesian network meta-analyses indicated that Shenmai injection, Shuxuening injection, Xinmailong injection, and Danhong injection ranked highest for improving response rates based on cardiac function (SUCRA: 89.2 %), partial pressure of oxygen (PaO₂) (SUCRA: 97.0 %), partial pressure of carbon dioxide (PaCO₂) (SUCRA: 89.7 %), and blood oxygen saturation (SaO₂) (SUCRA: 99.0 %), respectively. Honghua injection showed the strongest effects in reducing mean pulmonary arterial pressure (mPAP) (SUCRA: 88.0 %) and increasing forced expiratory volume in one second as a percentage of prediction (FEV₁ % pred) (SUCRA: 87.7 %). All reported adverse events were mild.

Conclusions

TCM injections are generally effective and safe complementary therapies for G3PH. Shenmai injection, Honghua injection, Shuxuening injection, Xinmailong injection, and Danhong injection emerged as the most effective options for improving various outcomes, including response rate, mPAP, FEV₁ % pred, PaO₂, PaCO₂, and SaO₂. However, the evidence quality ranges from moderate to very low due to risks of bias, imprecision, and heterogeneity among the included RCTs.

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中药注射剂治疗3组肺动脉高压的证据构建：70项随机对照试验的贝叶斯网络meta分析

中药注射剂在治疗与3组肺动脉高压（G3PH）相关的原发性疾病并预防其进展方面具有潜力。然而，具体结果的最佳干预措施仍不清楚。方法从8个数据库中选取截至2024年12月26日的随机对照试验（rct）。采用风险偏倚2 （Risk of Bias 2, RoB 2）工具评价纳入的随机对照试验的偏倚风险。采用贝叶斯网络meta分析评价中药注射剂治疗G3PH的疗效。根据累积排序曲线（SUCRA）下曲面对中药注射剂的有效性和安全性进行排序。结果纳入70项随机对照试验，17支中药注射剂，6148例患者。根据罗布2评估，65项和5项随机对照试验分别被归类为“有一些担忧”或“高”偏倚风险。贝叶斯网络meta分析显示，参脉注射液、舒血宁注射液、心脉龙注射液和丹红注射液在改善心功能（SUCRA: 89.2%）、氧分压（PaO2）（SUCRA: 97.0%）、二氧化碳分压（PaCO2）（SUCRA: 89.7%）和血氧饱和度（SaO2）（SUCRA: 99.0%）方面的有效率最高。红花注射液在降低平均肺动脉压（mPAP）（supra: 88.0%）和增加1秒用力呼气量（FEV1 % pred）（supra: 87.7%）方面的作用最强。所有报告的不良事件都是轻微的。结论stcm注射是治疗G3PH有效、安全的补充疗法。参麦注射液、红花注射液、舒血宁注射液、心脉隆注射液和丹红注射液是改善各种结局的最有效选择，包括有效率、mPAP、FEV1 % pred、PaO2、PaCO2和SaO2。然而，由于纳入的随机对照试验存在偏倚、不精确和异质性风险，证据质量从中等到极低不等。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Integrative Medicine INTEGRATIVE & COMPLEMENTARY MEDICINE-

CiteScore

4.70

自引率

4.00%

发文量

102

审稿时长

33 days

期刊介绍： The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education. EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians. The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.