联合血塞通对比单纯西药治疗脑梗塞临床疗效的Meta分析

Meta-analysis on Clinical Efficacy of Combined Xuesaitong versus Western Medicine in the Treatment of Cerebral Infarction

目的系统评价2011年1月至2020年2月血塞通联合西药治疗脑梗塞的临床疗效。方法检索中国知网、万方数据、维普网、中国生物医学文献数据库、PubMed、Embase、the Cochrane Library、Clinical Trials共8个数据库,根据PICOS原则制定纳入标准。纳入文献的研究对象为脑梗塞患者,对照组接受阿司匹林、阿托伐他汀、依达拉奉的治疗,试验组在对照组基础上联合应用血塞通。结局指标为治疗前后NIHSS评分、基于NIHSS评分的疗效判定和不良事件情况。利用考克兰偏倚风险评估工具进行质量评价,采用Rev Man 5.3软件进行数据处理。结果共纳入10篇文献,Meta分析显示:试验组与对照组的治疗后NIHSS评分差异具有统计学意义,总体效应检验结果[MD=-2.52,95%CI (-2.76,-2.27),P<0.00001];两组在疗效判定为基本痊愈、显著进步及无变化或恶化时的差异具有统计学意义。基本痊愈[OR=1.88,95%CI (1.40,2.53),P<0.0001],显著进步[OR=1.68,95%CI (1.30,2.17),P<0.000 1],进步[OR=0.84,95%CI (0.63,1.10),P=0.21],无变化和恶化[OR=0.26,95%CI (0.18,0.37,P <0.000 01)];不良事件的发生情况,两组间差异无统计学意义[OR=0.80,95%CI(0.45,1.44,P=0.47)]。结论联合应用血塞通对比单纯西药治疗脑梗塞,更能够改善患者治疗后NIHSS评分,减轻了患者神经功能缺损程度,临床治疗效果更好,并且能降低治疗无效和病情恶化的可能性,无明显增加不良事件的风险,为临床提供了更优的治疗策略。

Objective The aim of this study was to systematically evaluate the clinical efficacy of Xuesaitong combined with Western medicine in the treatment of cerebral infarction from January 2011 to Feburary 2020.Methods 8 electronic databases, namely CNKI, Wan Fang,VIP,CBM,PubMed,Embase,the Cochrane Library and Clinical Trials, were searched for literature review and the inclusion criteria were developed according to PICOS principles. The subjects included in the literature were patients with cerebral infarction. The control group was treated with aspirin, atorvastatin and edaravone. The experimental group was treated with Xuesaitong on the basis of the medicines used in the control group. The Cochrane bias risk assessment tool was used for quality evaluation, and the data was combined using Rev Man 5.3 software. Results Meta-analysis showed that: the difference of NIHSS score between the experimental group and the control group after treatment was statistically significant,and the overall effect test result was [MD =-2.52,95% CI(-2.76,-2.27), P < 0.00001]. The differences were statistically significant between the two groups when the curative effect was judged to be basically cured,significantly improved and no change or deteriorating. Basic recovery [OR = 1.88,95% CI(1.40,2.53),P < 0.0001],significant progress [OR = 1.68,95% CI(1.30,2.17),P < 0.0001], progress [OR = 0.84,95%CI(0.63,1.10), P = 0.21], no change or deterioration [OR = 0.26,95% CI(0.18,0.37,P < 0.00001) ].In terms of occurrence of adverse events, there was no statistical difference between the two groups [OR=0.80,95%CI(0.45,1.44,P = 0.47) ]. Conclusion The combination of Xuesaitong injection and Western medicine can decrease the NIHSS score of patients after treatment, reduce the degree of neurologic impairment of patients,improve the clinical treatment effect, and reduce the possibility of invalid treatment and disease deterioration.Without significantly increasing the risk of adverse events,this method provides providing a better treatment strategy for the clinical practice.