从循证医学角度看阿尔茨海默病的治疗  

Treatment of Alzheimer disease:an evidence-based review

作　　者：纪荣芳[1] 牛建昭[1] 许树强[2] 李健[1] 王继峰[1] 刘建平[3] 

机构地区：[1]北京中医药大学细胞生物化学实验室,北京100029 [2]卫生部中日友好医院,北京100029 [3]北京中医药大学循证医学中心,北京100029

出　　处：《中西医结合学报》2007年第3期247-254,共8页Journal of Chinese Integrative Medicine

基　　金：国家自然科学基金资助项目(No.30371775No.30510403202No.30540420032);教育部长江学者和创新团队发展计划资助项目(No.IRT0413);教育部博士点基金资助项目(No.200500260120)

摘　　要：目的:运用循证医学理论评价中西医疗法治疗阿尔茨海默病的证据强度,为未来的临床研究及决策提供参考依据。方法:依据制定的检索策略严格筛选评价合格文献。对所纳入的文献资料进行定性及定量分析,包括描述性分析、同质性检验、meta分析、敏感性分析及亚组分析。结果:目前,西医对阿尔茨海默病以神经传导介质类药物为主流,其疗效优于非神经传导介质类药物。中医治疗此病的优势尚需更多设计严谨的研究来证实。发表于2002年以后及以迷你心智状态检查表为疗效评价标准的研究同质性较高。比较性研究较试验性研究估算的比值比高1.5倍,以中医药学会制定的结果指标所估算的疗效为迷你心智状态检查表指标的2.58倍(4.79/1.86)。结论:符合纳入标准的试验不多,且入选的随机试验和(或)半随机试验质量不高,比较性研究之证据等级也不高,在此基础上的meta分析结果外在效度较低。中医药治疗阿尔茨海默病的有效性仍需要研究质量良好的随机对照试验之科研成果来支持。Objective： resea rc hes The purpose of this research was mainly two-fold： first, to get an understanding of current conducted on Alzheimer disease in China; second, to systematically evaluate and compare Alzheimers treatment delivered by traditional Chinese medicine （TCM） and Western medicine. Methods. Two steps were employed in this research. They were data collection and cleaning, followed by systemic review and qualitative analysis. The data were selected from the following two databases. CNKI （http.//www. cnki. net） and Wanfang Data （http：//www, wanfangdata, com. cn）. Inclusion criteria were. （1） Chinese literature; （2） Published between year 1994 and year 2004; （3） Using TCM as treatment and Western medicine as control; （4） Similar research purposes and methodology; （5） Subjects were diagnosed as Alzheimer disease. Descriptive analysis , homogeneity test, meta analysis, sensitivity analysis and subgroup analysis were performed in the second step. Results： Supposing all qualified studies were of high quality, we got the following conclusion： the advantage of TCM was losing because of the newly-developed acetylcholinesterase inhibitors came in market. Moreover, the studies conducted after year 2002 were more homogeneous in comparison with those conducted in early years, Those studies using mini-mental status examination （MMSE） as outcome measurement were also more homogeneous than non-MMSE measurement groups. Combined odds ratio in comparative studies was 1.5 fold higher than that in experimental studies, Regarding to different outcome measurement, those studies using TCM assessment profile were 2.58（4.79/1.86） fold higher than those using MMSE as outcome measurement. Conclusions： After systemic literature search, we found that only 40 out of 2 403 studies met our inclusion criteria. Moreover, those qualified studies were of low quality. Therefore, the external validity of this study would be compromised, The solution to this would be to improve study q

关 键 词：循证医学 阿尔茨海默病 数据分析 统计 中医疗法 

分 类 号：R749.16[医药卫生—神经病学与精神病学]