口服中成药治疗急性脑梗死的网状Meta分析

Network Meta-analysis of oral Chinese patent medicine in treatment of acute cerebral infarction

运用网状Meta分析的方法系统评价口服中成药治疗急性脑梗死的效果。计算机检索四大中文数据库(CNKI,VIP,WanFang,SinoMed)和三大英文数据库(Medline,EMbase,Cochrane Library),检索时间为各数据库建库至2018年6月,按照预先设定的纳排标准筛选出治疗急性脑梗死的随机对照试验。由2名研究者独立进行文献筛选、资料提取。采用Cochrane协作网的ROB工具对纳入研究进行质量评价,WinBUGS 1.4.3和Stata 13.0软件进行数据分析。最终纳入52个RCT,涉及11种口服中成药。网状Meta分析结果显示,在总有效率方面,疗效排序依次为:脑脉泰胶囊>消栓肠溶胶囊>安宫牛黄丸>养血清脑颗粒>复方丹参滴丸>脑心通胶囊>通心络胶囊>脑血疏口服液>逐瘀通脉胶囊>银杏叶片>复方丹参片;在神经功能缺损评分方面,疗效排序依次为:通心络胶囊>安宫牛黄丸>复方丹参滴丸>消栓肠溶胶囊>养血清脑颗粒>逐瘀通脉胶囊>脑心通胶囊>脑血疏口服液;在Barthel指数评分方面,疗效排序依次为:消栓肠溶胶囊>脑脉泰胶囊>脑血疏口服液>安宫牛黄丸>通心络胶囊>逐瘀通脉胶囊。不同口服中成药均能改善这些结局指标,但是疗效排序差异比较大,又因为研究文献数量较少且质量较低,故该结论仍需开展多中心、大样本、双盲随机试验加以论证。

The efficacy of oral Chinese patent medicine in the treatment of acute cerebral infarction was systematically evaluated by network Meta-analysis.The literature search was conducted in three English databases(Medline,EMbase and Cochrane Library)and four Chinese databases(CNKI,VIP,WanFang and SinoMed)from inception to June 2018,and the randomized controlled trials of acute cerebral infarction were screened out according to the pre-set criteria.Two reviewers independently screened out the literature by using pre-specified eligibility criteria,and assessed the quality of included studies according to the risk of bias tool of Cochrane Handbook 5.1.0.Data analysis was conducted by using Stata 13.0 and WinBUGS 1.4.3 software.Finally,52 RCT were included,involving 11 kinds of oral Chinese patent medicines.The results of the network Meta-analysis showed that in terms of the total effective rate,the order of efficacy was as follows:Naomaitai Capsules>Xiaoshuan Changrong Capsules>Angong Niuhuang Pills>Yangxue Qingnao Granules>Compound Danshen Dripping Pills>Naoxintong Capsules>Tongxinluo Capsules>Naoxueshu Oral Liquid>Zhuyu Tongmai Capsules>Yinxingye Tablets>Compound Danshen Tablets;in terms of neurological deficit scores,the order of efficacy was:Tongxinluo Capsules>Angong Niuhuang Pills>Compound Danshen Dripping Pills>Xiaoshuan Changrong Capsules>Yangxue Qingnao Granules>Zhuyu Tongmai Capsules>Naoxintong Capsules>Naoxueshu Oral Liquid;in terms of Barthel index score,the order of efficacy was:Xiaoshuan Changrong Capsules>Naomaitai Capsules>Naoxueshu Oral Liquid>Angong Niuhuang Pills>Tongxinluo Capsules>Zhuyu Tongmai Capsules.Although different oral Chinese patent medicines can improve these outcomes,the difference in efficacy ranking was relatively large.Because of the small number and low quality of research literature,the conclusion still needs to be proved by multi-center,large-sample,and double-blind randomized trials.