银杏达莫与丹参注射剂对照急性脑梗死的Meta分析

Yinxingdamo injection versus Dansen injection for treatment of acute cerebral infarction:A Meta analysis

背景:丹参注射剂和银杏达莫是治疗脑梗死的常用中药制剂。近年来,多篇临床研究证实银杏达莫治疗脑梗死的效果优于丹参注射剂。但由于病例数少,影响实验的可信度。目的:评价银杏达莫与丹参注射剂治疗急性脑梗死的临床疗效。方法:全面检索中国医院数字图书馆和万方数据库1998-01/2010-02发表的关于银杏达莫与丹参注射剂对照治疗急性脑梗死的随机对照临床试验。纳入符合1995年第4次全国脑血管病学术会议修订的脑梗死诊断标准,并经头颅CT或MRI扫描证实为急性脑梗死的患者。排除没有基础治疗,诊疗方法中含有其他影响疗效观察的因素或联合用药对结果有明显影响的研究。按Cochrane协作网的质量评价纳入研究的方法学质量,运用Jadad评分标准评价纳入文献的方法学质量,用ReviewManager5.0软件进行荟萃分析。临床评价指标包括治疗总有效率、血液流变学指标变化、神经功能缺损评分比较。结果与结论:共纳入15个随机对照研究,包括1614例患者。Meta分析结果显示,银杏达莫治疗急性脑梗死临床有效率明显高于丹参注射剂(OR=3.70,95%CI:2.81～4.88,P<0.01),改善血液流变学的作用明显强于丹参注射剂,血浆黏度效应值(SMD=-1.01,95%CI:-1.69～-0.32,P<0.01),红细胞聚集指数效应值(SMD=-0.25,95%CI:-0.36～-0.14,P<0.01);对神经功能缺损的恢复也明显强于丹参注射剂(SMD=-0.73,95%CI:-0.88～-0.59,P<0.01)。说明银杏达莫治疗急性脑梗死的疗效优于丹参注射剂。

BACKGROUND：Dansen injection and Yinxingdamo injection are common used in the treatment of acute cerebral infarction.Many articles have confirmed that the outcomes of Yinxingdamo injection are superior to Dansen injection.However,the deficient number of cases impacts the credibility of the articles.OBJECTIVE：To analyze the clinical efficacy of Yinxingdamo injection and Dansen injection in treatment of acute cerebral infarction and to make an objective evaluation.METHODS：A thorough literature search of random controlled test about Yinxingdamo injection and Dansen injection in treatment of acute cerebral infarction was performed in Chinese hospital library and Wanfang Database published from January 1998 to February 2010.Inclusive criteria：according to the revised acute cerebral infarction diagnosis standard of the fourth national cerebrovascular disease academic conference held in 1995,patients have been diagnosed to be acute cerebral infarction by head CT or the MRI.Exclusive criteria：Documents lack of foundation treatment,the methods of diagnosis and treatment involved other factors which had influence to the clinical efficacy,or drug combination had significant influence to the result.The Meta-analyze was performed by ReviewManager 5.0.Clinical assessment index including total effective rate,changes of hemorheology and neurologic impairment scores.RESULTS AND CONCLUSION：Fifteen literatures including 1 614 cases were subsumed.Compared with Dansen injection,the total clinical effective rate of Yinxingdamo injection was more higher（OR=3.70,95%CI：2.81-4.88,P 0.001）;the changes of blood plasma viscosity of Yinxingdamo injection were more greater,the blood plasma viscosity was（SMD=-1.01,95%CI：-1.69 to-0.32,P 0.001） and the red blood cell accumulation index（SMD=-0.25,95%CI：-0.3 to-0.14,P 0.01）;the recovery of neurologic impairment of Yinxingdamo injection was stronger（SMD=-0.73,95%CI：-0.88 to-0.59,P 0.001）.It can be initially proved that Yinxingdamo injection has superior efficacy on acute cerebral infarction to Dansen injection.