从肝脾论治方药治疗儿童抽动障碍有效性和安全性的系统评价

Efficacy and Safety of the Prescription of Liver and Spleen for Pediatric Tic Disorders: a Systematic Review

目的 系统评价从肝脾论治方药治疗儿童抽动障碍的有效性和安全性。方法 计算机检索PubMed、the Cochrane Library、万方(WanFang Data)、中国知网(CNKI)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)中从肝脾论治方药治疗儿童抽动障碍的随机对照试验(RCTs)。两名研究者独立对文献进行筛选、提取,评价偏倚风险;运用RevMan 5.3软件进行Meta分析。结果 共纳入RCTs 22项,涉及病人1 886例。Meta分析结果显示:从肝脾论治方药在改善总有效率[RR=1.18,95%CI(1.10,1.27),P<0.000 01]、耶鲁综合抽动严重程度量表(YGTSS)评分[MD=-3.98,95%CI(-6.03,-1.92),P=0.000 2],YGTSS发声评分[MD=-2.71,95%CI(-3.44,-1.98),P<0.000 01]、YGTSS运动评分[MD=-4.10,95%CI(-5.07,-3.13),P<0.000 01]及减少6个月复发率[RR=0.36,95%CI(0.24,0.53),P<0.000 01]与不良反应发生率[RR=0.17,95%CI(0.11,0.25),P<0.000 01]方面均优于对照组。药物使用主归肝经(23.55%)、脾经(19.76%),以补益药、平肝息风药、解表药频次最高,其中茯苓、钩藤、白芍、白术、陈皮、天麻使用频次较高。结论 当前证据表明,从肝脾论治方药有效率较高,能有效改善YGTSS评分,且安全性较好,复发率较低;然而因纳入研究质量和数量情况,所得结论仍需更多高质量、设计严谨的研究验证。

Objective To systematically evaluate the efficacy and safety of the prescription of liver and spleen for pediatric tic disorders.Methods Databases including PubMed, the Cochrane Library, WanFang Data, CNKI,VIP,and CBM were searched to collect randomized controlled trials(RCTs) on the prescription of liver and spleen for pediatric tic disorders.Two researchers screened, extracted the literature, and assessed the risk of bias.And then the statistical analysis was performed by RevMan 5.3.Results A total of 22 RCTs involving 1 886 patients were adopted.The Meta-analysis results showed that, compared with control group, the prescription of liver and spleen on TD group was better in improving effective rate[RR=1.18,95%CI(1.10,1.27),P<0.000 01],Yale Global Tic Severity Scale(YGTSS) score[MD=-3.98,95%CI(-6.03,-1.92),P=0.000 2],YGTSS score of voice[MD=-2.71,95%CI(-3.44,-1.98),P<0.000 01],YGTSS score of motor[MD=-4.10,95%CI(-5.07,-3.13),P<0.000 01],reducing 6-month recurrence rate[RR=0.36,95%CI(0.24,0.53),P<0.000 01]and adverse reactions rate[RR=0.17,95%CI(0.11,0.25),P<0.000 01].Drugs return to the liver(23.55%) and spleen(19.76%) channels.The most popular Chinese medicine were Poria cocos, Uncaria rhynchophylla, White Paeony, Atractylodis macrocephalae, Citri Reticulatae Pericarpium, and Gastrodia elata.Conclusion Current evidence suggests that the prescription of liver and spleen could improve efficiency and YGTSS score, reduce recurrence rate and adverse reactions.More studies are required to verify the above conclusions.