活血化瘀通络法联合西药治疗血管性痴呆的系统评价及Meta分析

Systematic Review and Meta-Analysis on Efficacy of Promoting Blood Circulation and Removing Blood Stasis and Dredging Collaterals in Treatment of Vascular Dementia

目的 系统评价活血化瘀通络法联合西药治疗血管性痴呆(vascular dementia, VD)的有效率及临床疗效。方法 检索中国知网、万方、中国生物医学、Pubmed、Embase和Cochrane Library共6个数据库所有应用活血化瘀通络法治疗VD的临床随机对照试验,检索时限自建库至2021年7月21日,应用Review Manager 5.4软件进行Meta分析。结果 最终纳入33篇文献,纳入VD患者2807例。Meta分析结果表明:与对照组相比,活血化瘀通络法联合西药治疗能更有效的改善VD患者临床总有效率[RR=2.97,95%CI=(2.42,3.64),P<0.00001]、简明精神状态检查量表(MMSE)评分[MD=1.79,95%CI=(1.55,2.02),P<0.00001]、日常生活能力量表(ADL)评分[MD=-4.51,95%CI=(-5.01,-4.01),P<0.00001]、临床痴呆评定量表(CDR)评分[MD=-0.67,95%CI=(-0.76,-0.58),P<0.00001]、胆固醇(TC)水平[MD=-1.13,95%CI=(-1.31,-0.96),P<0.00001]、甘油三酯(TG)水平[MD=-0.36,95%CI=(-0.44,-0.28),P<0.00001]、高密度脂蛋白(HDL)水平[MD=0.18,95%CI=(0.13,0.23),P<0.00001]、低密度脂蛋白(LDL)水平[MD=-0.58,95%CI=(-0.73,-0.43),P<0.00001]、同型半胱氨酸(HCY)水平[MD=-3.93,95%CI=(-4.96,-2.89),P<0.00001]、全血高切浓度水平[MD=-0.74,95%CI=(-0.86,-0.62),P<0.00001]、血浆比黏度水平[MD=-0.08,95%CI=(-0.10,-0.06),P<0.00001],差异均具有统计学意义。结论 活血化瘀通络法联合西药治疗可提高VD患者临床疗效,改善VD患者认知能力、日常生活能力及临床痴呆程度,并可改善VD患者的血脂、HCY、全血高切浓度、血浆比黏度水平。

Objective To systematically evaluate the clinical efficacy of activating blood circulation, removing blood stasis and dredging collaterals(ARD) in the treatment of vascular dementia(VD).Methods Six databases including CNKI,Wanfang, CBM,Pubmed, Embase and Cochrane Library were searched for all the RCTs of ARD in the treatment of VD.The search time limit was from the establishment of the database to July 21,2021.Review Manager 5.4 software was used for Meta-analysis.Results Finally, 33 articles were included, including 2807 patients with VD.The results of Meta-analysis showed that compared with the control group, the method of ARD with western medicine treatment could more effectively improve the clinical total effective rate of VD patients[RR=2.97,95%CI=(2.42,3.64),P<0.00001],Mental State Examination Scale(MMSE) score[MD=1.79,95%CI=(1.55,2.02),P<0.00001],Activity of Daily Living Scale(ADL) score[MD=-4.51,95%CI=(-5.01,-4.01),P<0.00001],Clinical Dementia Rating Scale(CDR) score[MD=-0.67,95%CI=(-0.76,-0.58),P<0.00001],cholesterol(TC) level[MD=-1.13,95%CI=(-1.31,-0.96),P<0.00001],triglyceride(TG) level[MD=-0.36,95%CI=(-0.44,-0.28),P<0.00001],high-density lipoprotein(HDL) level[MD=0.18,95%CI=(0.13,0.23),P<0.00001],low-density lipoprotein(LDL) level[MD=-0.58,95%CI=(-0.73,-0.43),P<0.00001],homocysteine(HCY) level[MD=-3.93,95%CI=-0.801,-0.06,P<0.00001],the whole blood high shear concentration level[MD=-0.74,95%CI=(-0.86,-0.62),P<0.00001] and plasma specific viscosity level[MD=-0.08,95%CI=(-0.10,-0.06),P<0.00001].The differences were statistically significant.Conclusion ARD combined with western medicine can improve the clinical efficacy, the cognitive ability, the daily living ability and clinical dementia degree of VD patients, and can improve the blood lipid, HCY,whole blood high shear concentration and plasma specific viscosity level of VD patients.