中药复方联合西药治疗卒中后认知障碍的Meta分析  

Meta-analysis of Traditional Chinese Medicine Compound for Post-Stroke Cognitive Impairment

作　　者：尤丰玲 夏高富 刘亚林 蔡静 YOU Fengling;XIA Gaofu;LIU Yalin;CAI Jing(Guizhou University of Traditional Chinese Medicine,Guiyang 550002,Guizhou,China)

机构地区：[1]贵州中医药大学,贵阳550002 [2]贵州中药大学第一附属医院,贵阳550001

出　　处：《中西医结合心脑血管病杂志》2023年第22期4091-4100,共10页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：贵州省中医药管理局中医药、民族医药科学技术研究课题(No.QZYY2017-039);贵州省科技计划项目,编号:黔科合基础-ZK[2022]一般519;贵州中医药大学研究生教育创新计划自然科学项目建设任务(No.YCXZR2021008)。

摘　　要：目的:系统评价中药复方联合西药治疗卒中后认知障碍(PSCI)的有效性及对病人神经心理检测量表、神经功能评价量表与安全性的影响。方法:计算机检索PubMed、EMbase、the Cochrane Library、ClinicalTrials.gov、维普、中国生物医学文献数据库、万方数据库和中国知网,检索时限为建库至2021年5月31日,纳入中药复方治疗PSCI的随机对照试验。根据方案筛选研究,并评价文献质量,运用RevMan 5.3软件进行Meta分析。结果:最终纳入16项研究,涉及1 283例研究对象,其中治疗组641例,对照组642例,偏倚风险总体较高。Meta分析结果显示:中药复方联合西药治疗PSCI对比单纯西药更能显著提高病人临床有效率[RR=1.41,95%CI(1.29,1.54),P<0.000 01],改善简易精神状态检查量表(MMSE)评分[MD=2.30,95%CI(1.37,3.23),P<0.000 01]、蒙特利尔认知评估量表(MoCA)评分[MD=2.70,95%CI(2.21,3.18),P<0.000 01]、Barthel指数评定量表(BI)评分[MD=9.76,95%CI(6.42,13.11),P<0.01]、日常生活能力量表(ADL)评分[MD=-4.39,95%CI(-5.60,-3.18),P<0.01]、美国国立卫生研究院卒中量表(NIHSS)评分[MD=-1.45,95%CI(-2.04,-0.86),P<0.01],差异均有统计学意义;中国卒中量表(CSS)评分改善不明显[MD=-1.19,95%CI(-2.64,0.27),P=0.11],差异无统计学意义。纳入文献中有4项报道了不良反应,均为轻度不良反应。结论:现有证据表明,中药复方治疗PSCI安全、有效,且优于单用西药治疗。期望有更多大样本、高质量的研究来完善验证此结论。Objective:To systematically evaluate the efficacy of traditional Chinese medicine compound for post-stroke cognitive impairment(PSCI)and its effects on Neuropsychological Test Scale,Neurological Function Evaluation Scale,and safety.Methods:PubMed,EMbase,the Cochrane Library,ClinicalTrials.gov,VIP,China Biology Medicine Disc(CBM),WanFang Database,and China National Knowledge Infrastructure(CNKI)were electronically retrieved to collect randomized controlled trials of traditional Chinese medicine compound for PSCI from inception to May 31,2021.Literature was selected according to research needs,the quality of the literature was evaluated.RevMan 5.3 software was used for Meta-analysis.Results:Sixteen literature were included,involving 1283 subjects,including 641 cases in the treatment group and 642 cases in the control group,with an overall high risk of bias.The results of Meta-analysis showed that Chinese medicine compound combined with western medicine could significantly improve the effective rate of PSCI compared with western medicine alone(RR=1.41,95%CI 1.29-1.54,P<0.00001),improved Mini-mental State Examination(MMSE)score(MD=2.30,95%CI 1.37-3.23,P<0.00001),Montreal Cognitive Assessment(MoCA)score(MD=2.70,95%CI 2.21-3.18,P<0.00001),Barthel index(BI)score(MD=9.76,95%CI 6.42-13.11,P<0.00001),Activity of Daily Living(ADL)score(MD=-4.39,95%CI-5.60--3.18,P<0.01)and the National Institutes of Health Stroke Scale(NIHSS)score(MD=-1.45,95%CI-2.04--0.86,P<0.01),all with statistically significant differences.But there was no significant difference in Chinese Stroke Scale(CSS)score(MD=-1.19,95%CI-2.64-0.27,P=0.11).Four mild adverse reactions were reported.Conclusion:Existing evidence shows that TCM compounds are safe and effective in the treatment of PSCI,and are superior to western medicine alone.More large-sample,high-quality studies are expected to confirm this conclusion.

关 键 词：卒中后认知障碍 中药复方 神经心理检测量表 神经功能评价 安全性 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]