摘要
系统评价脑血疏口服液治疗急性脑梗死(ACI)的临床疗效。检索国内外数据库,经查重、筛选后对纳入的研究文献进行资料提取,采用Cochrane研发的偏移风险评估工具进行研究质量的分析,应用RevMan5.4对脑血疏口服液治疗ACI的神经功能、临床有效率、炎症反应、水肿增加率等进行Meta分析,运用GRADE系统对每个结局指标进行质量评价,形成推荐意见。共纳入14项研究,Meta分析显示,(1)在改善神经功能方面,脑血疏口服液+常规西医治疗优于常规西医治疗(MD_(NIHSS中(重)度))=-1.96,95%CI[-2.47,-1.45],P<0.00001;MD_(NIHSS重度)=-4.70,95%CI[-5.85,-3.55],P<0.00001;MD_(BDNF)=4.13,95%CI[2.53,5.72],P<0.00001;MD_(NSE)=-1.93,95%CI[-2.21,-1.74],P<0.00001);(2)临床有效率方面,NIHSS评分组脑血疏口服液+常规西医治疗有效率是常规西医治疗1.17倍(RR_(NIHSS)=1.17,95%CI[1.11,1.23],P<0.00001);NDS评分组治疗差异无统计学意义(RR_(NDS中度)=1.16,95%CI[0.97,1.38],P=0.11;RR_(NDS重度)=1.62,95%CI[1.07,2.44],P=0.02);(3)炎症反应方面,脑血疏口服液+常规西医治疗抑制炎症的疗效更显著(MD_(超敏CRP)=-2.49,95%CI[-2.97,-2.01],P<0.00001);(4)治疗脑水肿方面,脑血疏口服液+常规西医优于常规西医治疗(MD_(水肿增加率)=-21.47,95%CI[-24.14,-18.80],P<0.00001)。对结局指标进行证据等级的评价,结果显示各结局指标证据等级均为低级,推荐强度为弱推荐。结果表明,脑血疏口服液联合西医治疗可改善急性脑梗死后的神经功能,减轻水肿及炎症指标,提高临床疗效,但受研究质量限制,仍待更多严谨、样本量大的研究进行确认。
Objective To systematically evaluate the clinical effect of Naoxueshu Oral Liquid(脑血疏口服液)in the treatment of acute cerebral infarction(ACI).Methods We searched databases,extracted the data of the included research literature after checking and screening,and analyzed the research quality by using the Cochrane risk bias assessment tool,RevMan5.4 was used to conduct a Meta-analysis of the neurological function,clinical efficacy,inflammatory reaction and edema increase rate of Naoxueshu Oral Liquid in the treatment of ACI.Results A total of 14 studies were included.Meta-analysis results:(1)In terms of improving neurological function,NXS+western medicine treatment was superior to western medicine treatment(MDNIHSS=-1.96,95%CI[-2.47,-1.45],P<0.00001;MDNIHSS/severe=-4.70,95%CI[-5.85,-3.55],P<0.00001;MDBDNF=4.13,95%CI[2.53,5.72],P<0.00001;MD_(NSE)=-1.93,95%CI[-2.21,-1.74],P<0.00001).(2)In terms of the total clinical efficiency,the effective rate of NXS+western medicine was 1.17 times as that of western medicine(RRNIHSS=1.17,95%CI[1.11,1.23],P<0.00001).NXS+western medicine and western medicine(RR_(NDS/moderate)=1.16,95%CI[0.97,1.38],P=0.11;RRNDS/severe=1.62,95%CI[1.07,2.44],P=0.02).(3)In terms of inflammatory reaction,the effect of NXS+western medicine on inhibiting inflammation was more significant(MDhs-CRP=-2.49,95%CI[-2.97,-2.01],P<0.00001).(4)In terms of cerebral edema,NXS+western medicine treatment was superior to western medicine treatment(MD=-21.47,95%CI[-24.14,-18.80],P<0.00001).Conclusion The result showed that the evidence grade of every outcome index was low and the recommendation intensity was weak.Naoxueshu Oral Liquid combined with western medicine can improve the neurological function,reduce edema and inflammatory index,and improve clinical curative effect for acute cerebral infarction.However,due to the low quality of the research,it was expected to carry out standardized design and large-sample clinical studies in the future in the treatment of ACI.
作者
陈媛朋
王宝亮
CHEN Yuanpeng;WANG Baoliang(Henan University of Chinese Medicine,Zhengzhou,450046,Henan,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China)
出处
《实用中医内科杂志》
2021年第11期4-8,I0003,I0004,共7页
Journal of Practical Traditional Chinese Internal Medicine
基金
国家中医药管理局第六批全国老中医药专家学术继承项目(国中医药人教发[2017]29号)
河南省中医药科学研究专项研究(TCM2019010)。
关键词
脑血疏口服液
急性脑梗死
系统评价
META分析
Naoxueshu Oral Liquid(脑血疏口服液)
acute cerebral infarction
systematic review
Meta-analysis
