中成药治疗儿童注意缺陷多动障碍的贝叶斯网状Meta分析

Bayesian network Meta-analysis of Chinese patent medicines in treatment of attention deficit hyperactivity disorder in children

目的运用贝叶斯网状Meta分析方法比较不同中成药治疗儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的疗效差异。方法检索建库至2021年7月1日的PubMed、EMbase、Cochrane Library、中国知网数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(Wanfang)、维普数据库(VIP)中关于中成药治疗儿童ADHD的随机对照试验,依据Cochrane系统评价手册中的策略评价纳入文献质量,并运用贝叶斯网状Meta分析比较不同中成药的疗效差异。结果最终纳入50篇文献,涉及6种中成药(静灵口服液、小儿智力糖浆、小儿黄龙颗粒、多动宁胶囊、地牡宁神口服液、九味镇心颗粒),共4445例患者。网状Meta分析结果显示,在有效率方面,静灵口服液联合化学药、九味镇心颗粒联合化学药、小儿黄龙颗粒、小儿黄龙颗粒联合化学药、小儿智力糖浆、小儿智力糖浆联合化学药优于单独化学药治疗,优劣概率排序前3分别是九味镇心颗粒联合化学药>小儿黄龙颗粒联合化学药>小儿智力糖浆联合化学药。在Conners简明症状问卷(abbreviated symptom questionnaire,ASQ)评分方面,静灵口服液联合化学药优于单独化学药治疗,优劣概率排序前3分别是地牡宁神口服液联合化学药>静灵口服液联合化学药>九味镇心颗粒联合化学药。在Conners症状问卷评分方面,各指标概率前3名排序:多动指数评分为小儿黄龙颗粒联合化学药>小儿智力糖浆联合化学药>小儿黄龙颗粒;多动冲动评分为小儿智力糖浆>小儿智力糖浆联合化学药>多动宁胶囊联合化学药;品行问题评分为小儿智力糖浆联合化学药>静灵口服液>多动宁胶囊联合化学药;学习问题评分为多动宁胶囊联合化学药>静灵口服液>小儿智力糖浆联合化学药;身心障碍评分为静灵口服液>小儿智力糖浆联合化学药>多动宁胶囊联合化学药;焦虑评分为多动宁胶囊联合化学药>小儿智力糖浆联合化学药>静灵口服液。在安全性方面,6种中成药均具有较好的安全性,未增加不良反应的发生率。结论中成药治疗儿童ADHD疗效显著。就治疗有效率而言,九味镇心颗粒联合化学药、小儿黄龙颗粒联合化学药、小儿智力糖浆联合化学药疗效较优。由于所纳入研究方法学质量偏低,结果应该被谨慎解释,且结论有待今后更多高质量研究加以验证。

Objective The Bayesian network Meta-analysis method was used to compare the efficacy differences between Chinese patent medicines in the treatment of children with attention deficit hyperactivity disorder(ADHD).Methods Randomized controlled trials on the treatment of children with ADHD with Chinese patent medicines were searched from PubMed,EMbase,Cochrane Library,China National Knowledge Infrastructure Database(CNKI),China Biology Medicine Database(CBM),Wanfang Database(Wanfang),and VIP Database(VIP)with the database establishment to July 1,2021.The quality of the included literature was evaluated according to the strategy in the Cochrane systematic review manual,and the efficacy differences of different Chinese patent medicines was compared using Bayesian network Meta-analysis.Results Finally,a total of 50 literatures were included,involving six kinds of Chinese patent medicines[Jingling Oral Liquid(静灵口服液),Xiaoer Zhili Syrup(小儿智力糖浆),Xiaoer Huanglong Granules(小儿黄龙颗粒),Duodongning Capsules(多动宁胶囊),Dimu Ningshen Oral Liquid(地牡宁神口服液),and Jiuwei Zhenxin Granules(九味镇心颗粒)],involving 4445 patients.The results of the network Meta-analysis showed that in terms of effective rate,Jingling Oral Liquid combined with western medicine,Jiuwei Zhenxin Granules combined with western medicine,Xiaoer Huanglong Granules,Xiaoer Huanglong Granules combined with western medicine,Xiaoer Zhili Syrup,and Xiaoer Zhili Syrup combined with western medicine were better than western medicine alone.The top three in terms of probability were Jiuwei Zhenxin Granules combined with western medicines,Xiaoer Huanglong Granules combined with western medicines,and Xiaoer Zhili Syrup combined with western medicines.In terms of Conners abbreviated symptom questionnaire(ASQ)score,Jingling Oral Liquid combined with western medicine was better than western medicine alone.The top three in terms of probability were Dimu Ningshen Oral Liquid combined with western medicine,Jingling Oral Liquid combined with western medicine,and Jiuwei Zhenxin Granules combined with western medicine.In terms of Conners symptom questionnaire score,the probability of each index ranked top three:hyperactivity index score was Xiaoer Huanglong Granules combined with western medicines,Xiaoer Zhili Syrup combined with western medicines,and Xiaoer Huanglong Granules;The hyperactivity impulse score was Xiaoer Zhili Syrup,Xiaoer Zhili Syrup combined with western medicines,and Duodongning Capsules combined with western medicines;The conduct problem score was Xiaoer Zhili Syrups combined with western medicines,Jingling Oral Liquid,and Duodongning Capsules combined with western medicines;The learning problem score was Duodongning Capsules combined with western medicines,Jingling Oral Liquid,and Xiaoer Zhili Syrup combined with western medicine;The physical and mental disability score,Jingling Oral Liquid,Xiaoer Zhili Syrup combined with western medicine,Duodongning Capsules combined with western medicine;The anxiety score was Duodongning Capsules combined with western medicine,Xiaoer Zhili Syrup combined with western medicines,and Jingling Oral Liquid.In terms of safety,the six Chinese patent medicines had good safety,and did not increase the incidence of adverse reactions.Conclusion Chinese patent medicine is effective in the treatment of children with ADHD.In terms of effective rate,Jiuwei Zhenxin Granules combined with western medicine,Xiaoer Huanglong Granules combined with western medicine,and Xiaoer Zhili Syrup combined with western medicine have better curative effects.Due to the low methodological quality of the included research,this result should be interpreted with caution,and the conclusion needs to be verified by more high-quality studies in the future.