中西医结合治疗糖尿病性脑梗死系统评价研究  

Treatise review of Chinese and western medicine treatment of diabetic cerebral infarction

作　　者：葛金文[1] 邓奕辉[1] 徐美灵[2] 

机构地区：[1]湖南中医药大学血管生物学实验室,长沙410208 [2]浙江省湖州市中心医院,湖州313000

出　　处：《中华中医药杂志》2010年第11期1852-1857,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：湖南省中医药科研基金资助课题(No.2009021)~~

摘　　要：目的:参照国际循证医学中心随机对照文献质量评价标准研究中西医结合治疗糖尿病性脑梗死文献质量,并与单纯西医治疗糖尿病性脑梗死进行比较。方法:收集中西医结合治疗糖尿病性脑梗死临床研究随机对照文献,评价了文献的数量、质量、干预措施等,并运用Meta分析方法比较中西医结合与单纯西医治疗糖尿病性脑梗死的总有效率、神经功能缺损评分(NDS)、空腹血糖(FBG)和糖化血红蛋白(GHb)。结果:共收集文献1963篇,其中符合meta-分析要求的文献59篇,Jaded评分>3分的高质量文献仅1篇;研究总有效率的文献52篇、神经功能缺损评分18篇、空腹血糖14篇、糖化血红蛋白6篇、血脂11篇、血液流变学18篇;34篇文献使用了中药汤剂,中药使用频次在10次以上者依次为黄芪(28)、地龙(27)、丹参(21)、川芎(20)、生地黄(19)、当归(18)、水蛭(15)、麦冬(13)、葛根(12)、桃仁(12)、赤芍(11)、石菖蒲(10);中西医结合治疗临床总有效率为92.17%,单纯西医治疗组为74.44%,两组差异显著(Z=14.88,P<0.01);两组NDS加权均数差(WMD)为-4.60分,95%可信区间为(-5.47,-3.73)分,差异有统计学意义(Z=10.41,P<0.01);两组FBG加权均数差为-0.93mmol/L,95%可信区间为(-1.57,-0.28)mmol/L,差异有显著性(Z=2.82,P<0.01);两组GHb加权均数差为-0.60%,95%可信区间为(-1.69,0.49)%,差异无统计学意义。结论:中西医结合治疗糖尿病性脑梗死的临床研究较多,但大多没有采取随机对照和双盲试验,文献质量普遍偏低;有限证据显示中西医结合治疗糖尿病性脑梗死在临床总有效率、改善神经功能缺损评分和空腹血糖等方面明显优于单纯西医治疗组,而在改善糖化血红蛋白方面两组作用基本一致。受纳入研究的数量和质量限制,中西医结合治疗对糖尿病性脑梗死血糖的影响需要更多高质量的随机双盲对照试验加以证实。Objective： To study the treatise quality of Chinese and Western medicine treatment of diabetic cerebral infarction acording to the treatise evaluation criteria from International Center for Evidence-Based Medicine and compare the clinical curative effect between the two methods. Methods： Collect completely the clinic study of Chinese medicine for diabetic cerebral infarction, choose the eligibility studies and appraise their quality, and choose the eligibility studies and make Meta- analysis to the total efficiency, neurological deficit score（NDS） , fasting blood glucose（FBG）and glycohemoglobin（GHb. Results： Collected 1963 papers of Chinese and Western medicine treatment of diabetic cerebral infarction from 1978 to 2009, of which, 59 papers meet the requirements of meta-analysis and only 1 paper was classified to high quality treatise with above 3 Jaded score. Of the 59 papers, 52 papers researched the total effective rate, 18 papers neurological deficit score, 14 papers fasting blood glucose, 6 papers glycohemoglobin, 11papers blood lipid, 18 papers hemorheology. 34 papers used TCM decoction. Chinese medicine above 10 using frequency is successively astragalus（28）,lumbricus（27）, salvia（21）, Chuanxiong（20）, habitat（19）, Angelica（18）, leech（15）, ophiopogon（13）, pueraria（12）, Taoren（12）, paeonia（11）, Shichangpu（10）. The total efficiency, neurological deficit, FBG and GHb were respectively researched in 52 papers, 18 papers, 14 papers and 6 papers. Meta-analysis revealed that the total efficiencyof integration of Chinese Western Medcine （ICWM） group（92.17 percent） markedly exceeded to only western medicine treatment group（74.44 percent, Z=14.88, P0.01）, the weighted mean difference（WMD） of NDS was -4.6 points（95% CI -5.47,-3.73 ）with obvious significance（Z=10.41, P0.01）, the WMD of FBG was -0.93 mmol/L（95% CI -1.57,-0.28）with obvious significance（Z=2.82, P0.01）and the WMD of GHb with -0.60% （95% CI -1.69%, 0.49%）was n

关 键 词：文献评价/循证医学 糖尿病/脑梗死 中西医结合 随机对照双盲试验 META-分析 神经功能缺失 空腹血糖 糖化血红蛋白 

分 类 号：R587.1[医药卫生—内分泌] R743.3[医药卫生—内科学]