补肾养肝法治疗帕金森病有效性和安全性的系统评价

Systematic Review of the Efficacy and Safety of Bushen Yanggan in the Treatment of Parkinson′s Disease

目的系统评价补肾养肝法治疗帕金森病的有效性和安全性。方法计算机检索The Cochrane Library、PubMed、中国生物医学文献数据库(CBM)、EMbase、Web of Science、万方数据库、维普、中国知网(CNKI)等医学数据库中符合纳入标准的随机对照临床试验(RCT),检索时限为建库至2020年1月,获得相关数据后,按照Cochrane风险评价表和Jadad质量评分法进行文献质量评价,通过RevMan 5.3软件进行Meta分析。结果共纳入随机对照试验11项,涉及790例病人,其中试验组395例,对照组395例。Meta分析结果显示:试验组临床疗效总有效率高于对照组[OR=2.84,95%CI(1.45,5.57),Z=3.04,P=0.002],帕金森综合评分量表(UPDRS)评分[MD=-8.84,95%CI(-13.20,-4.49),Z=3.98,P<0.0001]、中医证候评分[MD=-7.86,95%CI(-12.16,-3.57),Z=3.59,P=0.0003]、多巴制剂使用量[MD=-169.49,95%CI(-254.15,-84.84),Z=3.92,P<0.0001]、日常生活能力量表(ADL)评分[MD=-4.88,95%CI(-6.67,-3.09),Z=5.35,P<0.00001]均低于对照组,差异均有统计学意义。试验组不良反应发生率低于对照组,差异有统计学意义[OR=0.34,95%CI(0.14,0.81),Z=2.45,P=0.01]。结论现有证据表明,补肾养肝法治疗帕金森病对比单纯西药治疗的临床疗效更佳,能明显提高总有效率,改善病人UPDRS评分、中医证候评分、ADL评分,减少多巴制剂使用量及不良反应。

Objective To systematically evaluate the efficacy and safety of Bushen Yanggan in the treatment of Parkinson′s disease.Methods Randomized controlled trials(RCTs)from the Cochrane Library,PubMed,CBM,EMbase,Web of Science,Wanfang database,VIP,and CNKI were collected.The retrieval time was up to January 2020.The quality of literature was evaluated according to the Cochrane quality risk evaluation and the Jadad score method.Meta analysis was performed using RevMan 5.3 software.Results Eleven RCTs with 790 patients were included,there were 395 patients in experimental group and 395 patients in control group.The results of meta-analysis showed that compared with control group,the total clinical effective rate[OR=2.84,95%CI(1.45,5.57),Z=3.04,P=0.002],the UPDRS score[MD=-8.84,95%CI(-13.20,-4.49),Z=3.98,P<0.0001],traditional Chinese medicine(TCM)syndrome score[MD=-7.86,95%CI(-12.16,-3.57),Z=3.59,P=0.0003],the dopa dosage[MD=-169.49,95%CI(-254.15,-84.84),Z=3.92,P<0.0001],Activities of Daily Living(ADL)score[MD=-4.88,95%CI(-6.67,-3.09),Z=5.35,P<0.00001]in experimental group were lower.The incidence of adverse reactions in experimental group were lower than that in control group[OR=0.34,95%CI(0.14,0.81),Z=2.45,P=0.01].Conclusion The available evidence suggests that,Bushen Yanggan is more effective than that of western medicine in the treatment of Parkinson′s disease,ADL score,and reduce the dopa dosage with less adverse reactions.