中药辅助左旋多巴类药物改善帕金森病疗效的Meta分析

Meta-analysis of effectiveness of traditional Chinese medicine as adjuvant therapy of Levodopa medicine for Parkinson disease

目的：系统评价中药辅助左旋多巴类药物治疗帕金森病的效果。方法从中国期刊全文数据库（CNKI）、维普期刊数据库（VIP）、中国生物医学文献数据库（CBM）、万方数据知识资源系统、PubMed、Springer-link、EBSCO、Elsevier-SDOL中检索1994年10月～2014年10月关于中药辅助左旋多巴类药物治疗帕金森病的临床随机对照研究，结局指标为帕金森病统一评分量表（UPDRS），根据纳入标准和排除标准筛选文献，统计所纳入文献的数据，利用Revman 5.3软件对数据进行Meta分析。结果共纳入19篇符合标准的随机对照临床研究，患者共有1352例，对照组（单用左旋多巴类药物或加模拟药）671例，治疗组（采用中药加左旋多巴类药物）681例。 Meta分析结果显示，与对照组比较，治疗组可以降低UPDRS积分，差异有统计学意义。 UPDRSⅠ[W MD=-0.76，95%CI（-1.30，-0.23），P =0.005]，UPDRSⅡ[WMD =-3.07，95%CI（-4.18，-1.97），P〈0.00001]，UPDRSⅢ[WMD =-4.09，95%CI（-5.05，-3.12），P〈0.00001]，UPDRSⅡ与Ⅲ积分和[W MD=-7.01，95%CI（-11.61，-2.41），P=0.003]，UPDRSⅣ[SMD=-0.63，95%CI（-1.00，-0.26），P=0.0009]，UPDRS总积分[SMD =-7.32，95%CI（-8.50，-6.13），P〈0.00001]。结论中药联合左旋多巴类药物在改善帕金森病症状方面疗效优于单用左旋多巴类药物。

Objective To assess the effectiveness of traditional Chinese medicine （TCM） as adjuvant therapy of Levodopa medicine in improving symptom of Parkinson disease. Methods Clinical randomized controlled trials on TCM as adjuvant therapy of Levodopa medicine in improving symptom of Parkinson disease were searched from databases of CNKI, VIP, CBM, Wanfang, PubMed, Springerlink, EBSCO, Elsevier-SDOL from October 1994 to October 2014. Outcome measure was unified Parkinson disease rating scale （UPDRS）. According to the inclusion criteria and exclusion criteria literatures were selected and Revman 5.3 was utilized for a Metaanalysis on data collected from litera-tures. Results 19 randomized controlled trials were concluded. A total of 1352 cases were included, control group （Levodopa medicine or plus placebo） were 671 cases and experimental group （TCM and Levodopa medicine） were 681 cases. Outcome of Meta-analysis showed that the scores of UPDRS in experimental group were lower than control group and the difference was statistically significant. UPDRSⅠ [W MD=-0.76, 95%CI （-1.30,-0.23）, P=0.005], UPDRSII[W MD=-3.07, 95%CI （-4.18,-1.97）, P〈0.000 01], UPDRSⅢ[W MD=-4.09, 95%CI （-5.05, -3.12）, P〈0.000 01], UPDRSII and UPFRSⅢ [W MD=-7.01, 95%CI （-11.61,-2.41）, P=0.003], UPDRSⅣ [SMD=-0.63, 95%CI （-1.00,-0.26）, P= 0.0009], the total score of UPDRS [SMD =-7.32, 95%CI （-8.50, -6.13）, P〈 0.000 01]. Conclu-sion The effectiveness of TCM as adjuvant therapy of Levodopa medicine is better than only using Levodopa medicine in improving symptom of Parkinson disease.