精选中药制剂治疗颈动脉粥样硬化的疗效与安全性：系统评价与荟萃分析。
完整摘要 · 中文译文
背景：尽管针对颈动脉粥样硬化（CAS）的常规疗法仍是标准治疗，但其疗效往往有限，且伴随不良反应。中草药（CHM）是治疗CAS的一种有前景的辅助疗法；然而，支持其疗效和安全性的有力临床证据仍然有限。 目的：本系统评价和荟萃分析评估中草药治疗CAS的疗效和安全性，并描述其用药规律。 方法：检索了五个数据库，检索时间自建库至2025年12月。纳入评估口服中草药治疗CAS的随机对照试验（RCT）。使用Cochrane偏倚风险2（RoB 2）工具评估研究质量。使用RevMan v5.3和R软件提取和分析数据。通过meta回归和亚组分析探究异质性来源。网络分析揭示了21项研究中的中草药用药规律。 结果：共纳入21项RCT，涉及3，078例患者。与单纯常规治疗相比，加用中草药显著降低颈动脉斑块面积（MD = 4.94，95% CI：3.13至6.76，p < 0.01）、内中膜厚度（IMT）（MD = 0.12，95% CI：0.07至0.17，p < 0.05）、总胆固醇（TC）（MD = 0.32，95% CI：0.22至0.42，p < 0.01）、甘油三酯（TG）（MD = 0.24，95% CI：0.11至0.37，p < 0.01）和低密度脂蛋白胆固醇（LDL-C）（MD = 0.37，95% CI：0.21至0.53，p < 0.01），同时大幅提高高密度脂蛋白胆固醇（HDL-C）（MD = -0.20，95% CI：-0.29至-0.10，p < 0.01）。中草药并未显著 增加不良事件风险（RR = 0.84，95% CI：0.64至1.10，p = 0.20）或损害肝/肾功能。网络分析确定核心作用为化痰和祛瘀，丹参（Salvia miltiorrhiza Bge.）和半夏[Pinellia ternata (Thunb.) Breit.]作为发挥抗瘀和调脂作用的关键植物药。 结论：作为常规治疗的辅助手段，中药（CHM）可能进一步降低颈动脉内膜中层厚度（IMT）和斑块负荷，改善脂质代谢，并表现出良好的安全性特征。然而，纳入研究的整体质量和异质性限制了证据强度，凸显了需要设计良好、高质量随机对照试验（RCT）来证实这些发现。 系统评价注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261285381，注册号CRD420261285381。
完整摘要 · 英文原文
BACKGROUND: Although conventional therapies for Carotid atherosclerosis (CAS) remain the standard treatment, their effectiveness is often limited and accompanied by adverse effects. Chinese herbal medicine (CHM) is a promising adjunctive therapy for CAS; however, robust clinical evidence supporting its efficacy and safety remains limited. OBJECTIVE: This systematic review and meta-analysis evaluates the efficacy and safety of CHM for CAS treatment and characterizes its medication patterns. METHODS: Five databases were searched from inception to December 2025. Randomized controlled trials (RCTs) evaluating oral CHM for CAS were included. Study quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data were extracted and analyzed using RevMan v5.3 and R software. Sources of heterogeneity were investigated through meta-regression and subgroup analyses. Network analysis reveals herbal medication patterns across 21 studies. RESULTS: Twenty-one RCTs involving 3,078 patients were included. Compared with conventional therapy alone, adjunctive CHM significantly reduced carotid plaque area (MD = 4.94, 95% CI: 3.13 to 6.76, p < 0.01), intima-media thickness (IMT) (MD = 0.12, 95% CI: 0.07 to 0.17, p < 0.05), total cholesterol (TC) (MD = 0.32, 95% CI: 0.22 to 0.42, p < 0.01), triglycerides (TG) (MD = 0.24, 95% CI: 0.11 to 0.37, p < 0.01), and low-density lipoprotein cholesterol (LDL-C) (MD = 0.37, 95% CI: 0.21 to 0.53, p < 0.01), while greatly increasing high-density lipoprotein cholesterol (HDL-C) (MD = -0.20, 95% CI: -0.29 to -0.10, p < 0.01). CHM did not significantly increase the risk of adverse events (RR = 0.84, 95% CI: 0.64 to 1.10, p = 0.20) or impair liver/kidney function. Network analysis identified core actions as clearing phlegm and removing blood stasis, with Danshen (Salvia miltiorrhiza Bge.) and Banxia [Pinellia ternata (Thunb.) Breit.] as pivotal botanical drugs exerting anti-stasis and lipid-regulating effects. CONCLUSION: As an adjunct to conventional therapy, CHM may further reduce carotid IMT and plaque burden, improve lipid metabolism, and demonstrate a favorable safety profile. However, the overall quality and heterogeneity of the included studies limit the strength of the evidence, highlighting the need for well-designed, high-quality RCTs to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261285381, identifier CRD420261285381.