基于网状Meta分析评价经典名方治疗痴呆的疗效与安全性

Based on network meta⁃analysis,to evaluate the efficacy and safety of classic prescriptions for the treatment of dementia

目的:运用网状Meta分析方法比较和评价经典名方治疗痴呆的疗效与安全性,并分别进一步比较不同方剂治疗老年性痴呆(阿尔茨海默,Alzheimer’s disease,AD)与血管性痴呆(Vacualar dementia,VD)两大类西医病症的临床疗效。方法:计算机检索中国知网(CNKI)、万方数据库(WangFang Date)、维普(VIP)、中国生物医学文献服务系统(CBM)、PubMed、Cochrane Library数据库,搜集近十年来临床应用较多的经典名方(地黄饮子、益气聪明汤、六味地黄汤、黄连解毒汤)治疗痴呆(包括AD和VD)的随机对照试验(RCT)。参照Cochrane5.1.0版系统评价手册中纳入与排除标准,由2名研究者各自独立的筛选、提取和评估文献,采用Stata16.0、RevMan5.4软件进行网状Meta分析。结果:纳入文献32篇,共2 606例患者,涉及9种干预措施。其中老年性痴呆共1 786例患者,涉及8种干预措施;血管性痴呆共820例患者,涉及6种干预措施。Meta分析结果显示:(1)改善痴呆有效率方面,最有效的3种治疗方式为益气聪明汤联合常规西药>益气聪明汤>六味地黄汤联合常规西药;(2)改善老年性痴呆有效率方面,最有效的3种治疗方式为益气聪明汤联合常规西药>地黄饮子>地黄饮子联合常规西药;(3)改善血管性痴呆有效率方面,最有效的3种治疗方式益气聪明汤>益气聪明汤联合常规西药>六味地黄汤联合常规西药;(4)改善痴呆MMSE评分方面,最佳的3种治疗方式为益气聪明汤联合常规西药>六味地黄汤联合常规西药>地黄饮子联合常规西药;(5)改善老年性痴呆MMSE评分方面,最佳的3种治疗方式为益气聪明汤联合常规西药>黄连解毒汤联合常规西药>六味地黄汤联合常规西药;(6)改善血管性痴呆MMSE评分方面,最佳的3种治疗方式为益气聪明汤联合常规西药>六味地黄汤联合常规西药>益气聪明汤;(7)代表方在ADL评分方面具有优势性,差异具有统计学意义[MD=7.24,95%CI(4.30,10.17),P<0.000 01]。结论:经典名方联合常规西药治疗痴呆具有优势性;此外无论是否考虑AD与VD的差异性,益气聪明汤及其联合疗法在临床有效率和智能状态改善上均为最佳方式;今后仍需开展更多更高质量的相关研究以修正和验证本文所得结果。

Objective:To evaluate the efficacy and safety of classical prescriptions in treatment of by network meta-analysis,and further compare the clinical efficacy of senile dementia(Alzheimer dementia,AD)and vascular dementia(VD)with different prescriptions.Methods:Using computer search CNKI,WangFang Date,VIP,CBM,PubMed,Cochrane Library database,col-lect the classic prescriptions(Dihuang yinzi,Yiqi congming soup,Liuwei dihuang soup,Huanglian jiedu soup)with more clinical applications for dementia(including AD and VD)randomized controlled trial(RCT)in the past decade.According to the inclu-sion and exclusion criteria in the Cochrane version 5.1.0 systematic review manual,two review authors independently screened,extracted and evaluated the literature,and used Stata16.0 and RevMan5.4 software for network meta-analysis.Results:Thirty two articles were included in the literature,with a total of 2606 patients involving 9 interventions.Among them,there were 1786 patients with senile dementia involving 8 interventions and 820 patients with vascular dementia involving 6 interventions.Meta-analysis results showed that:(1)in terms of improving the effectiveness of dementia,the three most effective ways are Yiqi congming soup combined with conventional western medicine>Yiqi congming soup>Liuwei dihuang soup combined with con-ventional western medicine,(2)in terms of improving the effectiveness of senile dementia,the three most effective ways are Yiqi congming soup combined with conventional western medicine>Dihaung yinzi>Dihaung yinzi combined with conventional west-ern medicine,(3)in terms of improving the effectiveness of vascular dementia,the most effective 3 ways to Yiqi congming soup>Yiqi congming soup with conventional western medicine>Liuwei dihuang soup with conventional western medicine,(4)in terms of improving the MMSE score of dementia,the best three treatment methods are yiqi smart soup combined with conventional western medicine>Liuwei dihuang soup combined with conventional western medicine>Dihaung yinzi combined with conven-tional western medicine,(5)in terms of improving the MMSE score of senile dementia,the best three treatment methods are Yiqi congming soup combined with conventional western medicine>Huanglian jiedu soup combined with conventional western medi-cine>Liuwei dihuang soup combined with conventional western medicine,(6)in terms of improving the MMSE score of vascular dementia,the best three treatment methods are Yiqi congming soup combined with conventional western medicine>Liuwei di-huang soup combined with conventional western medicine>Yiqi congming soup;(7)The ADL score was statistically significant[MD=7.24,95%CI(4.30,10.17),P<0.00001].Conclusion:Classical representatives and combined conventional western medicine have advantages in treating dementia.In addition,regardless of the difference between AD and VD,Yiqi congming soup and its combination therapy is the best way to improve the clinical efficiency and intelligent status.More higher-quality,relevant studies are still needed to correct and validate the results obtained in this paper.