中医疗法与胆碱酯酶抑制剂治疗阿尔茨海默病的网状Meta分析

Chinese Medicine Therapy and Cholinesterase Inhibitors for the Treatment of Alzheimer’s Disease:A Network Meta-analysis

目的:本研究采用网状Meta分析的方法,以胆碱酯酶抑制剂(Cholinesterase Inhibitors,ChEIs)作为共同参照,评价现有各种中医疗法对比ChEIs对阿尔茨海默病(Alzheimer’s disease,AD)的临床疗效。方法:全面检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、VIP、Wan-Fang数据库中已公开发表的中医疗法与ChEIs治疗AD的临床随机对照试验,检索时限截至2020年10月24日。数据分析采用ADDIS、Review Manager 5.3和STATA 13.1。结果:纳入56个随机临床对照试验(Randomized Controlled Trial,RCT),共计4732例AD患者,涉及13种治疗方式。网状Meta分析结果显示:在总有效率与简易智能精神状态检查(Mini-Mental State Examination,MMSE)量表评分改善方面,中药+电针([OR=15.30,95%CI(2.43,128.12)]、[MD=8.58,95%CI(4.08,12.99)])为最优方案;在日常生活活动(Activity of daily living,ADL)量表评分改善方面,电针+ChEIs[MD=9.26,95%CI(1.95,16.50)]为最优方案;在所有排序预测中,除中药+ChEIs以外,无论是中医综合疗法还是中西医联合运用均优于某一疗法的单独运用。结论:中医综合疗法和中西医联合运用均优于ChEIs的单独运用。因此,认为临床治疗AD患者认知功能障碍可优先考虑中医综合疗法或与ChEIs联合运用。基于纳入研究的局限,本结论仍需更多高水平RCT予以论证。

Objective:This study adopted the method of network meta-analysis,using cholinesterase inhibitors(ChEIs)as a common reference,to evaluate the superiority of various traditional Chinese medicine therapies in comparison with ChEIs in the clinical efficacy of Alzheimer’s disease(AD).Methods:The clinical randomized controlled trials of TCM therapy and cholinesterase inhibitor in the treatment of Alzheimer’s disease published in PubMed,The Cochrane Library(issue 10,2020),EMbase,CNKI,CBM,VIP and Wan-Fang databases were searched comprehensively.The search time limit is as of October 24,2020.Data analysis adopts ADDIS,Review Manager 5.3 and STATA 13.1.Results:A total of 4732 AD patients in 56 RCTs were included,involving 13 treatment methods.The results showed that TCM+EA was the best scheme in the improvement of total effective rate and MMSE score,and EA+ChEIs was the optimal solution in the improvement of ADL score.In all the sequencing predictions,except TCM+ChEIs,both the comprehensive therapy of TCM and the combination of TCM and western medicine were superior to a single application of a certain therapy.Conclusion:The combined application of Chinese medicine and western medicine was superior to the single application of ChEIs.Therefore,it is believed that the clinical treatment of cognitive dysfunction in patients with AD can give priority to the comprehensive therapy of traditional Chinese medicine or the combined application of ChEIs.Based on the limitations of the included studies,this conclusion still needs more high-level RCTs to demonstrate.