补肾法治疗阿尔茨海默病的系统评价

A systematic review of TCM tonifying kidney therapy for Alzheimer’s disease

[目的]对涉及补肾法中药治疗阿尔茨海默病(AD)的临床试验进行系统评价,总结规律,以期促进中医药合理使用。[方法]计算机检索检索CNKI、万方、PubMed等数据库,检索时间为自建库至2019年5月22日,筛选补肾法中药治疗AD的随机对照试验(RCT),依据RevMan 5.3说明进行质量评价,采用RevMan 5.3进行Meta分析。[结果]共纳入29项RCT,包括2 291例患者,根据中药功效进一步区分为补肾(10篇),补肾健脾(5篇),补肾化痰(5篇),补肾活血(9篇)。补肾法能够改善AD的简易精神状态检查(MMSE),与多奈哌齐疗效相当。补肾法联合多奈哌齐治疗优于多奈哌齐单一治疗(MMSE,MD=3.62,95%CI:0.83~6.40,P=0.01)。补肾健脾同样可改善AD的认知功能。补肾化痰、补肾活血对已接受多奈哌齐治疗的AD患者的MMSE及日常生活能力(ADL)具有增效作用。补肾活血法联合多奈哌齐可改善AD患者的精神行为症状(NPI),疗效优于单纯多奈哌齐(MD=-3.93,95%CI:-4.89~-2.98,P<0.001)。[结论]中药补肾法、补肾健脾法对AD患者的认知有益,补肾化痰和补肾活血法联合西药对AD的认知功能和日常生活能力具有增效作用,补肾活血法对AD的精神行为症状有益。

[Objective]To systematically review the clinical trials of traditional Chinese medicine of tonifying kidney therapy for treating Alzheimer’s disease(AD)dementia,and summarize the law in order to promote the rational use of traditional Chinese medicine.[Methods]To retrieved CNKI,Wanfang data,Pubmed,by computer,the search deadline was May 22,2019.The randomized controlled trials(RCTs)of AD dementiathe treatment of with Chinese herbal medicine was screened.The quality evaluation was carried out according to the Jadad scale and RevMan 5.3.Meta-analysis was performed on RevMan 5.3.[Results]A total of 29 RCTs were included,including 2291 patients.They were further divided into Bushen(10 articles),Bushen Jianpi(5 articles),Bushen Huatan(5 articles),Bushen Huoxue(9 articles).The Bushen therapy improved the mini-mental state examination(MMSE)score of AD patients,and there was no significant difference compared with donepezil.The combination of Bushen and donepezil was superior to donepezil monotherapy(MD=3.62,95%CI:0.83~6.40,P=0.01).Bushen Jianpi also benefited AD in MMSE.The combination therapy of Bushen Huatan or Bushen Huoxue had a synergistic effect on cognition(MMSE)in those treated with donepezil.Bushen Huoxue improved mental behavioral symptoms(neuropsychiatric inventory,NPI)in those treated with donepezil(MD=-3.93,95%CI:-4.89~-2.98,P<0.001).[Conclusion]Bushen therapy can improve cognition in AD patients.Chinese medicine(Bushen Jianpi,Bushen Huatan or Bushen Huoxue)combined with western medicine(e.g.donepezil)had synergistic effect on cognitive function and activities of daily living,and Bushen Huoxue had a better effect on behavioral symptoms.