银杏叶提取物治疗痴呆的系统综述(英文)  

Ginkgo biloba extract for dementia: a systematic review

作　　者：姜丽娟[1] 苏立杰[2] 崔慧茹[1] 任娟娟[1] 李春波[1] 

机构地区：[1]上海交通大学医学院附属精神卫生中心 [2]同济大学同济医院急诊科

出　　处：《上海精神医学》2013年第1期10-21,共12页Shanghai Archives of Psychiatry

基　　金：supported by the Med-X Research Funding to the Shanghai Jiao Tong University, the Shanghai Program for Fostering Scientific Leaders in Health (No. XBR2011005)

摘　　要：背景痴呆的疾病负担不断增加,而且缺乏有效的治疗方法,因此有些国家就推荐使用银杏叶提取物(ginkgo biloba extract,GbE)来治疗痴呆,虽然有关GbE疗效的研究结果尚不一致。目的就银杏叶提取物对痴呆患者认知功能和日常生活能力改善作用的研究进行meta分析。方法检索国内外数据库,找出1982年1月—2012年9月发表的关于银杏叶提取物治疗(不少于22周)痴呆患者的随机安慰剂对照研究的文献报告。根据GRADE系统推荐的方法进行文献质量评估并提取资料。采用RevMan5.1软件进行异质性检验、敏感性分析并评估发表偏倚。对连续性变量的合并效应值采用标准均差(Standardized mean differences,SMD)表示,对分类变量则采用相对危险度(relative risk,RR)表示,meta分析的合并结果采用森林图显示。结果有9项研究共计2578例患者符合入组和排除标准。其中6项研究共计1917例患者纳入meta分析,结果发现仅在样本年龄相对较低(平均年龄75岁以下)的研究中GbE在延缓认知功能衰退和防止日常活动能力下降方面优于安慰剂。组间脱落率以及治疗中总的不良事件发生率均无显著差异。然而,不同研究结果间存在明显的异质性(主要是因为研究对象的年龄差异),文献存在可能的发表性偏倚(大多数是医药公司资助的),因此总体证据强度属于"低"。结论这一meta分析表明,现有对此重要问题的研究证据依然极其薄弱。GbE对75岁以下存在痴呆的人群可能有效。需要大样本、安慰剂对照的随机研究来验证上述结果,今后的研究应当聚焦于程度较轻的痴呆(包括轻度认知功能障碍),比较不同剂量GbE的效果,并且随访更长的时间(至少1年)。Background： Given the increasing burden of dementia countries are already recommending the use of ginkgo b inconsistent research results about its effectiveness. nternationally and the lack of effective treatments, several oba extract （GbE） in the treatment of dementia, despite the Aim： Conduct a meta-analysis of studies about the effect of GbE on cognition and daily functioning in persons with dementia, Methods： Searches of various English and Chinese databases identified reports of placebo controlled, randomized trials of ginkgo biloba treatment （lasting a minimum of 22 weeks） for dementia that were published from January 1982 to September 2012. Data extraction and critical appraisa of studies were conducted using the GRADE system. Heterogeneity, sensitivity and potential publication bias of the studies were evaluated using RevMan 5.1. Pooled results of the meta- analysis were presented as forest plots using standardized mean differences （SMD） in scores for continuous variables and relative risk （RR） for categorical variables. Results： Nine studies with a total of 2578 patients met the inclusion and exclusion criteria. Pooled results from the six studies that were included in the meta-analysis （total n=1927） found that GbE was superior to placebo in preventing deterioration in cognitive functioning and in activities of dai y living, but these results were only valid for studies with younger subjects （with a mean age below 75）. There were no significant differences in the dropout rates between groups or in the overall rates of adverse events during treatment. However, there was considerable heterogeneity in the results between the studies （primarily based on the age of the subjects） and there were several potential biases in the reports （most of which were supported by pharmaceutical firms）, so the overall evidence was considered of ＇low quality＇. Conclusion： This meta-analysis highligl^ts serious weaknesses in the available studies about this important problem. GbE

关 键 词：银杏叶提取物 老年痴呆症 系统 认知功能障碍 千兆以太网 评价 临床试验 平均年龄 

分 类 号：R749.16[医药卫生—神经病学与精神病学]