养血清脑颗粒治疗血管性痴呆的系统评价

目的: 系统评价养血清脑颗粒治疗血管性痴呆的疗效及安全性。 方法: 计算机检索主要的中英文医学数据库,全面收集养血清脑颗粒治疗血管性痴呆的临床随机对照试验,根据Cochrane Handbook 5.1评价纳入研究的质量,并使用RevMan 5.3软件对纳入研究进行Meta分析,用漏斗图及Egger检验分析发表偏倚,GRADE profiler 3.6.1软件对证据质量进行评价。 结果: 共纳入10项研究,Meta分析提示养血清脑颗粒为主的治疗措施与常规西药治疗相比较,简明精神状态检查量表(MMSE)评分WMD=2.12,95%CI(1.61,2.63)],长谷川痴呆量表(HDS)评分WMD=3.98,95%CI(3.16,4.79)],日常生活能力评估量表(ADL)评分SMD=-0.62,95%CI(-0.80,-0.44)],差异均有统计学意义。在MMSE评分的亚组分析中,养血清脑颗粒为主的治疗措施优于多奈哌齐组、尼莫地平组和脑复康组,且安全性评价尚可,无发表偏倚。GRADE评价提示证据质量为低级。 结论: 养血清脑颗粒为主的治疗措施治疗血管性痴呆效果优于常规西药治疗。但由于本系统评价纳入研究的方法学质量较低,且例数较少,证据质量级别较低,因此临床医生使用该证据进行临床决策时尚需谨慎。

Systematic Evaluation of Yangxue Qingnao Granule in Treating Vascular Dementia

Objective: To systematically evaluate the efficacy and safety of Yangxue Qingnao granule (YQG) in treating vascular dementia (VD). Method: A computerized literature retrieval was carried out in main Chinese and English databases to collect randomized controlled trials (RCTs) for YQG in treating VD. The quality of all included trials was evaluated according to the Cochrane Handbook 5.1.RevMan 5.3 software was applied in a Meta-analysis on included studies. Funnel plot and Egger's test were used to analyze the publication bias. The quality of evidences was evaluated by GRADE profiler 3.6.1 software. Result: Altogether 10 studies were included. According to the Meta-analysis, compared with the conventional treatment with western medicines, the treatment with YQG showed statistical difference in mini-mental state examination (MMSE) scores WMD=2.12, 95%CI (1.61, 2.63)], Hasegawa dementia scale(HDS) scores WMD=3.98, 95%CI (3.16, 4.79)] and activity of daily living (ADL) scores SMD=-0.62, 95%CI (-0.80,-0.44)]. On the basis of the subgroup analysis on MMSE score, the treatment measures based on the YQG group was superior to that of the donepezil group, the nimodipine group and the piracetam group, with higher safety evaluation and no publication bias. The GRADE profile showed a low quality of evidences. Conclusion: The treatment measures based on YQG was superior to that of the conventional western medicines. However, clinicians shall sue the evidence cautiously due to the low methodology quality, a small number of studies included and lower evidence grade.