神经节苷脂GM1对脑外伤术后认知功能障碍疗效的Meta分析

Curative effect of monosialoganglioside GM1 on postoperative cognitive dysfunction in the patients with craniocerebral trauma: a meta-analysis

目的分析神经节苷脂GM1对脑外伤术后认知功能障碍的疗效。方法计算机检索Cochrane Library、EBSCO、EMbase、Springer、Ovid、Pub Med、CNKI、Wan Fang Data和CBM,收集神经节苷脂GM1治疗脑外伤术后认知功能障碍的随机对照试验(RCT),同时根据已纳入文章的参考文献查找所需文献,文献检索时间均为从建库至2017年5月。两位研究者独立提取纳入文献资料并评价纳入研究质量,采用Cochrane系统评价推荐软件Rev Man5.3进行定量Meta分析。结果共纳入8篇RCT,纳入患者573例。Meta分析结果显示:5篇文章(353例患者)比较了应用神经节苷脂治疗脑外伤术后认知功能障碍第1个疗程后对MMSE的影响,应用神经节苷脂治疗后的患者MMSE明显高于对照组[MD=3.57,95%CI(1.75,5.40),P<0.01]。5篇文章(353例患者)比较了神经节苷脂第二个疗程对MMSE的影响,应用神经节苷脂治疗2个疗程后的患者MMSE明显高于对照组[MD=4.45,95%CI(4.68,5.21),P<0.01]。7篇文章(513例患者)比较了完成神经节苷脂全部疗程后对MMSE的影响,应用神经节苷脂治疗后的患者MMSE明显高于对照组[MD=5.3,95%CI(4.51,608),P<0.01]。3篇文章发现研究组患者的总有效率明显高于对照组(P<0.01),[MD=5.11,95%CI(2.39,10.92),P<0.01]。1篇文章发现研究组的颅内压、血浆中的IL-6和TNF-α水平均低于对照组,大脑中动脉Vmean及Vmin均大于对照组(P<0.01)。结论现有研究表明,神经节苷脂GM1对脑外伤术后认知功能障碍的疗效明显。

Objective To systematically review the curative effects of monosialoganglioside GM1（GM1） on postoperative cognitive dysfunction after traumatic brain injury. Methods The randomized controlled trials（RCTs） about curative effect of monosialoganglioside GM1 on postoperative cognitive dysfunction in the patients with craniocerebral trauma were searched in Cochrane library, EBSCO, EMbase, Springer, Ovid, Pub Med, CNKI, Wan Fang Data, and CBM from their inception to May 2017, and the references of the included studies were also retrieved. The data of the included studies was extracted and evaluated by two researchers independently. Then meta-analysis was performed for the results of homogeneous studies by using The Cochrane Collaboration＇s Software Rev Man5.3. Results Eight RCT studies were analyzed in our study, including 573 patients. The results of meta-analysis showed that MMSE score after the first course of treatment with GM1 in five articles（including 353 patients） was significantly higher than that in the control group（MD=3.57, 95%CI（1.75, 5.40）, P〈0.01）. MMSE score after two courses of treatment with GM1 in five articles（353 patients）was significantly superior to that in the control group（MD=4.45, 95%CI（4.68, 5.21）, P〈0.01）. Meanwhile, MMSE scores in seven articles which finished all courses of treatment（involving 513 patients） were significantly superior to those in the control group（MD=5.3, 95%CI（4.51, 608）, P〈0.01）. The total effective rate in the study group was significantly higher than that in the control group in three articles（MD=5.11, 95%CI（2.39, 10.92）, P〈0.01）. In one article, the intracranial pressure, IL-6 and TNF-α levels in plasma of the study group were lower than those in the control group, and the Vmean and Vmin of middle cerebral artery were both higher than those in the control group（P〈0.01）. Conclusion GM1 has significant therapeutic values in treating postoperative cognitive dysfunction after traumatic brain injury.