中医药治疗轻度认知功能障碍的疗效评价

Therapeutic Efficacy Assessment of Chinese Medicine on Mild Cognitive Impairment

目的系统分析中医药治疗老年轻度认知障碍(mild cognitive impairment,MCI)的疗效及安全性。方法计算机检索PubMed、EMbase、Cochrane图书馆、中国期刊全文数据库、维普、万方数据库、中国生物医学数据库,在严格评估文献质量的基础上,使用GRADE评估证据质量。结果初检出文章680篇,最终筛选出22篇RCT论文进行分析。由于各个研究干预措施不同,故进行描述性分析。疗效评价:(1)MCI向阿尔茨海默病(AD)的转化率:加味五子衍宗颗粒及参银口服液中药组均无病例转化为MCI患者,但与安慰剂及维生素E比较差异无统计学意义;天泰1号与安慰剂比较差异有统计学意义。(2)认知功能改变:由于对照组选用药物不同,各中药的认知改善相对疗效不同。(3)MCI患者日常生活能力、血清SOD、MDA以及β淀粉样蛋白浓度的改善情况也因治疗药物的使用不同而疗效有差异。结论中药在治疗MCI方面有一定的疗效,但是由于文献质量普遍偏低,证据质量低,还不能据此做出临床应用的推荐。

Objective To systematically analyze the therapeutic efficacy and safety of Chinese medicine on aged patients with mild cognitive impairment （MCI）. Methods The PubMed, EMbase, Cochrane Library, CNKI, VIP, Wanfang Database, and CBM database were retrieved by computer. On the basis of strictly assess- ing the quality of literatures, the evidence quality was assessed using GRADE Software. Results Totally 680 papers were primarily retrieved and analyses were conducted in the finally selected 22 RCT articles. Descriptive analyses were conduced due to different interventions in each study. The therapeutic efficacy was assessed as follows. （1） As to the conversion of MCI to Alzheimer＇s disease （AD）, no case conversed to MCI in Jiawei Wuzi Yanzong Granule Group and Shenyin Oral Liquid Group. But there was no statistical difference when compared with that in the placebo group and the vitamin E group. Significant difference was shown between Tiantai No. 1 and the placebo. （2） As for the improvement of cognitive functions, relative therapeutic efficacies of Chinese herbs were different. （3） The improvement of the activities of daily life, serum SOD and MDA contents, and βamyloid concentration in MCI patients was different due to the application of different therapeutic drugs. Conclusion Chinese herbs showed certain therapeutic efficacy in improving MCI. But clinical application could not be recommended due to poor qualities of literatures and evidence.