中药注射液治疗血管性痴呆的网状Meta分析

Network Meta-analysis of traditional Chinese medicine injection in treatment of vascular dementia

目的系统评价中药注射液治疗血管性痴呆的疗效和安全性。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、万方(Wanfang Data)、维普(VIP)、中国知网(CNKI)和中国生物医学文献数据库(CBM),搜集建库至2022年3月25日所发表的中药注射液治疗血管性痴呆的随机对照试验(randomized controlled trials,RCTs),采用RevMan 5.3、Stata 15.0软件进行数据统计分析。结果最终纳入102项RCTs,包括12种中药注射剂和8806例患者。网状Meta分析显示:在提高临床有效率方面,累积排序曲线下面积(surface under the cumulative ranking curve,SUCRA)排名前3的治疗方案为黄芪注射液联合西医常规、血栓通注射液联合西医常规、参麦注射液联合西医常规;在改善简易智力状态检查量表(mini-mental state examination,MMSE)评分方面,SUCRA排名前3的治疗方案为参麦注射液联合西医常规、灯盏细辛注射液联合西医常规、舒血宁注射液联合西医常规;在改善日常生活活动能力量表(activities of daily living scale,ADL)评分方面,SUCRA排名前3的治疗方案为醒脑静注射液联合西医常规、黄芪注射液联合西医常规、银杏内酯注射液联合西医常规;在改善长谷川痴呆量表(Hasegawa dementia scale,HDS)评分方面,SUCRA排名前3的治疗方案为醒脑静注射液联合西医常规、疏血通注射液联合西医常规、银杏达莫注射液联合西医常规。安全性方面,治疗组不良反应发生事件少于对照组。结论在西医常规治疗的基础上,联合中药注射液可提高血管性痴呆的临床疗效。但鉴于不同治疗措施间纳入的研究质量、数量存在较大差异,中药注射液的SUCRA排序结果还有待今后开展高质量的多中心、大样本、随机双盲试验加以佐证。

Objective To evaluate the efficacy and safety of traditional Chinese medicine(TCM)injection in the treatment of vascular dementia.Methods Randomized controlled trials(RCTs)of TCM injection in the treatment of vascular dementia were collected by computer retrieval from PubMed,Cochrane Library,Embase,Web of Science,Wanfang,VIP,CNKI,and CBM.The search time was from the establishment to March 25,2022.The data were statistical analyzed by RevMan 5.3 and Stata 15.0.Results A total of 102 RCTs were included involving 12 TCM injections and 8806 patients.The results of network Meta-analysis showed that in terms of improving the rate of clinical effective,the top three in surface under the cumulative ranking curve(SUCRA)were conventional treatment of western medicine combined with Astragalus Injection(黄芪注射液),combined with Xueshuantong Injection(血栓通注射液),and combined with Shenmai Injection(参麦注射液);In terms of the improving mini-mental state examination(MMSE)score,the top three in SUCRA were conventional treatment of western medicine combined with Shenmai Injection,combined with Dengzhan Xixin Injection(灯盏细辛注射液),and combined with Shuxuening Injection(舒血宁注射液);In terms of the improving activities of daily living scale(ADL)score,the top three in SUCRA were conventional treatment of western medicine combined with Xingnaojing Injection(醒脑静注射液),combined with Astragalus Injection,combined with Ginkgolide Injection(银杏内酯注射液);In terms of the improving Hasegawa dementia scale(HDS)score,the top three in SUCRA were conventional treatment of western medicine combined with Xingnaojing Injection,combined with Shuxuetong Injection(疏血通注射液),and combined with Ginkgo Damo Injection(银杏达莫注射液).In terms of safety,the incidence of adverse reactions in the treatment group was less than that in the control group.Conclusion Base on the conventional treatment of western medicine,combined with TCM injection can improve the clinical effect in treatment of vascular dementia.However,there is a large difference in the quality and limited by the number of studies,the SUCRA cumulative sequencing results of TCM injection need to be verified by high-quality,multi-center,large-sample with randomized double-blind trials in the future.