通窍活血汤佐治血管性痴呆疗效及安全性Meta分析  

Efficacy and Safety of Tongqiao Huoxue Decoction for Vascular Dementia:A Meta-Analysis

作　　者：练景灏 周小琼 林东桥 向蕾 余尚贞[3] LIAN Jinghao;ZHOU Xiaoqiong;LIN Dongqiao;XIANG Lei;YU Shangzhen(Hunan University of Chinese Medicine,Changsha 410208,Hunan,China;Jinan University,Guangzhou 510000,Guangdong,China;Jiangmen Hospital of Traditional Chinese Medicine Affiliated to Jinan University,Jiangmen 529000,Guangdong,China)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]暨南大学中医学院,广东广州510000 [3]暨南大学附属江门医院脑病科,广东江门529000

出　　处：《实用中医内科杂志》2020年第11期55-61,共7页Journal of Practical Traditional Chinese Internal Medicine

基　　金：广东省名中医余尚贞传承工作室项目(粤中医办函[2017]17号)。

摘　　要：目的系统评价通窍活血汤治疗VD的疗效及安全性。方法计算机检索Pub Med、Web of Science、MEDLINE、Cochrane library、CNKI、CBM、VIP及Wan Fang Data,检索时间从各数据库建库至2019年10月。收集通窍活血汤治疗VD相关的临床随机对照试验(RCT)、半随机对照试验(quasi-RCT),采用Cochrane协作网系统评价方法及改良Jadad量表进行评价,使用Revman 5.3软件进行Meta分析。结果经筛选最终纳入9篇文献,共852例患者。Meta分析结果显示:①通窍活血汤联合常规西药治疗总有效率高于常规西药[RR=3.03,95%CI(2.11,4.35),P<0.00001];亚组分析:治疗时间4周≤t<8周[RR=2.55,95%CI(1.07,6.10),P=0.04],8周≤t<12周[RR=2.90,95%CI(1.10,7.64),P=0.03],t≥12周[RR=3.19,95%CI(2.06,4.93),P<0.00001],通窍活血汤联合常规西药均高于常规西药,且治疗时间t≥12周时,合并效应量最大。②MMSE评分亚组分析结果显示:治疗时间4周≤t<8周[MD=2.82,95%CI(1.89,3.76),P<0.00001],8周≤t<12周[MD=2.62,95%CI(0.98,4.25),P=0.002],t≥12周[MD=3.66,95%CI(2.79,4.53),P<0.00001],通窍活血汤联合常规西药均优于常规西药,当治疗时间t≥12周时,合并效应量最大。③ADL评分方面,各研究间异质性明显(P<0.00001,I2=93%),描述性分析结果示通窍活血汤联合常规西药优于常规西药。④描述性分析结果显示,通窍活血汤联合常规西药未增加不良反应发生风险。结论通窍活血汤治疗VD具有一定疗效,且具有一定安全性;通窍活血汤治疗VD的疗效与疗程相关;本系统评价纳入研究质量较低,例数偏少,今后仍需要进行更多高质量的随机对照试验研究以提供更可靠的循证医学证据。Objective To assess the efficacy and safety of Tongqiao Huoxue decoction(THD)on vascular dementia(VD).Methods All randomized controlled trials(RCTs)and quasi-randomized control trials(quasi-RCTs)about THD on VD were collected by electronically searching Pub Med,Web of Science,MEDLINE,Cochrane library,CNKI,CBM,VIP and Wan Fang from the earliest establishment time to October 2019.A Meta-analysis of relevant data were performed by using Rev Man5.3 software according to Cochrane systematic review and Modified Jadad scale.Results A total of 852 patients were included in 9 trials.The results of Meta-analysis:①Compared with that of the conventional western medicine group,the effective rate in the THD treatment group was enhanced[RR=3.03,95%CI(2.11,4.35),P<0.00001].According to treatment duration subgroup analysis:4 weeks≤t<8 weeks[RR=2.55,95%CI(1.07,6.10),P=0.04],8 weeks≤t<12 weeks[RR=2.90,95%CI(1.10,7.64),P=0.03],t≥12 weeks[RR=3.19,95%CI(2.06,4.93),P<0.00001],THD treatment group was superior to conventional western medicine group,and when the treatment duration was more than or equal to 12 weeks,the pooled effect was the largest.②MMSE subgroup analysis showed that the treatment duration was 4 weeks≤t<8 weeks[MD=2.82,95%CI(1.89,3.76),P<0.00001],8 weeks≤t<12 weeks[MD=2.62,95%CI(0.98,4.25),P=0.002],t≥12 weeks[MD=3.66,95%CI(2.79,4.53),P<0.00001],THD treatment group was superior to conventional western medicine groupand when the treatment duration was more than or equal to 12 w,the pooled effect was the largest.③In terms of ADL score,the heterogeneity among the studies was obvious(P<0.0001,I^2=93%).The results of descriptive analysis showed that THD treatment group was superior to conventional western medicine group.④Descriptive analysis showed that THD treatment group did not increase the risk of adverse reactions.Conclusion THD has certain effect and safety in the treatment of VD,which is related to treatment duration.Due to the lowquality of the study and few cases,more high-quality RCT studies should

关 键 词：通窍活血汤 血管性痴呆 META分析 随机对照试验 半随机对照试验 

分 类 号：R255.2[医药卫生—中医内科学]