Data Sheet 4_Efficacy and safety of Traditional Chinese Medicine in alleviating symptoms associated with myocardial bridge: a systematic review and meta-analysis.pdf

BackgroundWith the advancement of technology, the detection rate of myocardial bridge (MB) has gradually increased and attracted attention. However, management options for symptomatic MB are limited, and Traditional Chinese Medicine (TCM) has emerged as a potential complementary approach for managing symptoms in MB patients. This study conducted a meta-analysis by pooling data from clinical randomized controlled trials (RCTs) to assess the efficacy and safety of TCM in alleviating symptoms in patients with MB.
MethodsRCTs of TCM for MB were searched in PubMed, Embase, Web of Science, Cochrane Library, CBM, Wanfang, VIP, and CNKI databases from their inception to 1 April 2025. Patients diagnosed with MB via angiography were included in the study. The intervention group received either TCM alone (TCM-alone) or TCM combined with biomedicine (TCM + BM), while the control group received conventional biomedicine alone. Two investigators independently screened the literature according to the inclusion and exclusion criteria. The risk of bias in the included studies was assessed using Stata/MP 18.0 software. A meta-analysis was then conducted using RevMan 5.4.1 software to evaluate outcomes such as angina efficacy, electrocardiogram efficacy, TCM syndrome score efficacy, and the Seattle Angina Scale (SAQ). Subgroup analysis was performed according to the treatment regimen and duration of the intervention group.
ResultsA total of 18 publications were included, containing 1,224 participants, with 613 in the intervention group and 611 in the control group. Meta-analysis results showed that TCM significantly improved angina efficacy [RR = 1.30, 95% CI (1.21, 1.40), P < 0.00001], reduced angina attack frequency [MD = −0.96 episodes per week, 95% CI (−1.32, −0.59), P < 0.00001], improved electrocardiogram efficacy [RR = 1.31, 95% CI (1.20, 1.42), P < 0.00001], enhanced TCM syndrome scores [RR = 1.45, 95% CI (1.28, 1.64), P < 0.00001], and reduced physical limitation [MD = 5.95, 95% CI (2.25, 9.64), P = 0.002], angina stability [MD = 12.10, 95% CI (7.37, 16.83), P < 0.00001], angina frequency [MD = 11.29, 95% CI (6.93, 15.64), P < 0.00001], treatment satisfaction [MD = 23.44, 95% CI (19.26, 27.61), P < 0.00001], and disease perception [MD = 10.69, 95% CI (5.66, 15.72), P < 0.0001] scores in the SAQ, as well as Self-rating Anxiety Scale (SAS) [MD = −12.83, 95% CI (−13.95, −11.71), P < 0.00001] and Self-rating Depression Scale (SDS) [MD = −6.97, 95% CI (−8.41, −5.52), P < 0.00001] scores, and did not increase adverse reactions [RR = 0.82, 95% CI (0.51, 1.34), P = 0.43]. Subgroup analysis results indicated that, compared with the control group, both the TCM-alone [RR = 1.22, 95% CI (1.11, 1.34), P < 0.0001] and TCM + BM [RR = 1.38, 95% CI (1.24, 1.55), P < 0.00001] groups improved angina efficacy; the TCM + BM group improved ECG efficacy [RR = 1.26, 95% CI (1.16, 1.37), P < 0.00001] and TCM syndrome scores [RR = 1.54, 95% CI (1.30, 1.81), P < 0.00001], while the TCM-alone group did not improve ECG efficacy [RR = 1.53, 95% CI (0.92, 2.53), P = 0.10] or TCM syndrome scores [RR = 1.16, 95% CI (0.97, 1.40), P = 0.11]. Salvia miltiorrhiza Bunge [Lamiaceae; Salviae miltiorrhizae radix et rhizoma] and Ligusticum chuanxiong Hort. [Apiaceae; Chuanxiong rhizoma] are high-frequency medicinal substances for MB symptom management.
ConclusionTCM combined with biomedicine significantly improves angina symptoms, reduces attack frequency, enhances electrocardiographic parameters, alleviates TCM syndrome scores, and improves quality of life in patients with myocardial bridge, with a favorable safety profile. Crucially, TCM monotherapy showed no significant benefits for objective ischemia markers (ECG) or TCM syndrome scores, underscoring its role as a complementary adjunct rather than an alternative to standard care. However, these findings should be interpreted with caution due to the limited number of included RCTs, poor quality, small sample size, and single-center studies. Future large-scale, high-quality RCTs are warranted to confirm these results and further evaluate the efficacy and safety of TCM for symptom management in MB.
Systematic Review Registrationidentifier CRD420251000868.

背景 随着科技进步，心肌桥（myocardial bridge, MB）的检出率逐步提升并受到广泛关注。然而，有症状心肌桥患者的治疗选择十分有限，中医药（Traditional Chinese Medicine, TCM）已成为缓解该类患者症状的潜在补充疗法。本研究通过整合临床随机对照试验（randomized controlled trials, RCTs）数据开展Meta分析，旨在评估中医药缓解心肌桥患者症状的有效性与安全性。
方法 本研究检索了PubMed、Embase、Web of Science、Cochrane图书馆、中国生物医学文献数据库、万方、维普及中国知网自建库至2025年4月1日的中医药治疗心肌桥相关随机对照试验。纳入经血管造影确诊为心肌桥的患者。干预组接受单纯中医药治疗（TCM-alone）或中医药联合生物医学治疗（TCM + BM），对照组仅接受常规生物医学治疗。两名研究者按照纳入与排除标准独立筛选文献，采用Stata/MP 18.0软件评估纳入研究的偏倚风险，随后使用RevMan 5.4.1软件进行Meta分析，以评估心绞痛疗效、心电图疗效、中医证候评分疗效及西雅图心绞痛量表（Seattle Angina Scale, SAQ）等结局指标，并根据干预组的治疗方案与干预时长进行亚组分析。
结果 本研究共纳入18项文献，包含1224名受试者，其中干预组613例，对照组611例。Meta分析结果显示，中医药可显著提升心绞痛疗效[相对风险（RR）=1.30，95%置信区间（CI）(1.21, 1.40)，P < 0.00001]，降低心绞痛发作频率[均数差（MD）=-0.96 次/周，95%CI(-1.32, -0.59)，P < 0.00001]，改善心电图疗效[RR=1.31，95%CI(1.20, 1.42)，P < 0.00001]，提升中医证候评分疗效[RR=1.45，95%CI(1.28, 1.64)，P < 0.00001]，并可改善西雅图心绞痛量表中的躯体活动受限程度[MD=5.95，95%CI(2.25, 9.64)，P=0.002]、心绞痛稳定状态[MD=12.10，95%CI(7.37, 16.83)，P < 0.00001]、心绞痛发作频率[MD=11.29，95%CI(6.93, 15.64)，P < 0.00001]、治疗满意度[MD=23.44，95%CI(19.26, 27.61)，P < 0.00001]及疾病认知程度[MD=10.69，95%CI(5.66, 15.72)，P < 0.0001]评分，同时可降低焦虑自评量表（Self-rating Anxiety Scale, SAS）[MD=-12.83，95%CI(-13.95, -11.71)，P < 0.00001]与抑郁自评量表（Self-rating Depression Scale, SDS）[MD=-6.97，95%CI(-8.41, -5.52)，P < 0.00001]评分，且未增加不良反应发生风险[RR=0.82，95%CI(0.51, 1.34)，P=0.43]。亚组分析结果显示，与对照组相比，单纯中医药组[RR=1.22，95%CI(1.11, 1.34)，P < 0.0001]与中医药联合生物医学治疗组[RR=1.38，95%CI(1.24, 1.55)，P < 0.00001]均可提升心绞痛疗效；中医药联合生物医学治疗组可改善心电图疗效[RR=1.26，95%CI(1.16, 1.37)，P < 0.00001]及中医证候评分[RR=1.54，95%CI(1.30, 1.81)，P < 0.00001]，而单纯中医药组对心电图疗效[RR=1.53，95%CI(0.92, 2.53)，P=0.10]与中医证候评分[RR=1.16，95%CI(0.97, 1.40)，P=0.11]无显著改善作用。丹参（Salvia miltiorrhiza Bunge [唇形科；丹参]）与川芎（Ligusticum chuanxiong Hort. [伞形科；川芎]）是心肌桥症状管理中高频使用的中药材。
结论 中医药联合生物医学治疗可显著改善心肌桥患者的心绞痛症状、降低发作频率、提升心电图指标、缓解中医证候评分并改善生活质量，且安全性良好。值得注意的是，单纯中医药治疗对客观缺血标志物（心电图）及中医证候评分无显著获益，提示其仅可作为标准治疗的补充辅助手段，而非替代疗法。然而，由于纳入的随机对照试验数量有限、质量欠佳、样本量较小且多为单中心研究，解读本研究结果时需谨慎。未来需开展大规模、高质量的随机对照试验以验证本研究结果，并进一步评估中医药用于心肌桥症状管理的有效性与安全性。
系统评价注册 标识符：CRD420251000868。