清热化瘀汤治疗急性缺血性中风的Meta分析
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摘要
目的:系统评价清热化瘀汤治疗急性缺血性中风病人的临床疗效和安全性。方法:通过计算机检索CBM、CNKI、CMCC、VIP、万方医学网收集清热化瘀汤治疗急性缺血性中风的临床文献,时间限制为2000年1月—2017年5月,提取资料进行质量评价后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入14篇文献(共201例研究对象),其中9项试验对临床总有效率进行了评定,8项试验对神经功能缺损评分进行了评定,4项试验对中医证候积分值进行了评定,2项试验对病人日常生活能力进行了评定。试验临床总有效率的Meta分析结果提示清热化瘀汤组疗效优于对照组,(OR=3.64,95%CI[2.44--5.45],P<0.000 01);神经功能缺损评分的Meta分析结果提示清热化瘀汤组对神经功能缺损的改善程度优于对照组,(SMD=-4.41,95%[-5.66,-3.15],P<0.000 01);中医证候积分值疗效的Meta分析结果提示,清热化瘀汤组疗效优于对照组,(SMD=-6.17,95%[-9.63,-2.71],P<0.000 5);日常生活能力的Meta分析结果提示,清热化瘀汤组优于对照组(SMD=1.58,95%[1.19,1.98],P<0.000 01)。结论:清热化瘀汤治疗急性缺血性中风有明显疗效,且安全性较高,上述结论尚待进一步开展更多大样本、高质量研究予以证实。
Objective:To evaluate the clinical curative effect and safety of Qingre Huayu Decoction for treatment acute time of cerebral infarction. Methods: Major online databases including CBM,CNKI,VIP,CMCC and Wan Fang medical network were searched for a period between the time from January 2000 to May 2017 to collect RCT studies on Qingre Huayu Decoction in treatment acute time of cerebral infarction. The data was extracted for quality evaluation and analyzed by Rev Man 5. 3 software. Result: Fourteen RCT trials were included. A total of 201 subjects were enrolled. The Meta-analysis showed that applying Qingre Huayu Decoction for acute cerebral infarction had effective value. The test group was superior in elevating the clinical total effective rate( OR = 3. 64,95% CI[2. 44,5. 45],P < 0. 000 01). The ameliorating neural function defect in the test group was better( SMD =-4. 41,95% CI[-5. 66,-3. 15],P < 0. 000 01). The total effective rate of Chinese medical syndromes elevated( SMD =-6. 17,95% CI[-9. 63,-2. 71],P < 0. 000 5) and activities of daily life improved( SMD = 1. 58,95% CI[1. 19,1. 98],P < 0. 000 01). Conclusion: Qingre Huayu Decoction has obvious effect on the acute time of cerebral infarction and a higher security. The above conclusions still need further study in carrying out more large samples and confirming high quality studies.
Objective:To evaluate the clinical curative effect and safety of Qingre Huayu Decoction for treatment acute time of cerebral infarction. Methods: Major online databases including CBM,CNKI,VIP,CMCC and Wan Fang medical network were searched for a period between the time from January 2000 to May 2017 to collect RCT studies on Qingre Huayu Decoction in treatment acute time of cerebral infarction. The data was extracted for quality evaluation and analyzed by Rev Man 5. 3 software. Result: Fourteen RCT trials were included. A total of 201 subjects were enrolled. The Meta-analysis showed that applying Qingre Huayu Decoction for acute cerebral infarction had effective value. The test group was superior in elevating the clinical total effective rate( OR = 3. 64,95% CI[2. 44,5. 45],P < 0. 000 01). The ameliorating neural function defect in the test group was better( SMD =-4. 41,95% CI[-5. 66,-3. 15],P < 0. 000 01). The total effective rate of Chinese medical syndromes elevated( SMD =-6. 17,95% CI[-9. 63,-2. 71],P < 0. 000 5) and activities of daily life improved( SMD = 1. 58,95% CI[1. 19,1. 98],P < 0. 000 01). Conclusion: Qingre Huayu Decoction has obvious effect on the acute time of cerebral infarction and a higher security. The above conclusions still need further study in carrying out more large samples and confirming high quality studies.
引文
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[15]林卿.清热活血化瘀法治疗高血压性脑出血疗效观察附:132例病例报告[J].成都中医药大学学报,2001(3):52-53.
[16]汪庭龙.清热化瘀方对急性缺血性中风的临床疗效及对血清NSE的影响[D].南宁:广西中医药大学,2016.
[17]胡跃强,唐农.清热化瘀方对脑缺血预处理大鼠ATF4、Caspase-12表达的影响[J].时珍国医国药,2012(8):1849-1851.
[2]祝美珍,朱爱.加用清脑益元汤治疗痰热腑实型缺血性中风疗效观察[J].广西中药,2014(2):32-34.
[3]竺震雷.清热化瘀方对缺血性中风神经功能恢复和中医证候评分的影响[J].山西中医,2017(3):20-21.
[4]刘渝册,张玉梅.清热化瘀汤对急性期脑出血患者神经功能及预后的影响[J].山东医药,2016(29):76-78.
[5]唐映,刘杰文,胡国恒,等.清热化瘀汤治疗脑出血急性期30例疗效观察[J].湖南中医杂志,2015(7):35-36,63.
[6]杨宁,陆倩,夏毅,等.清热化瘀汤对33例缺血性脑卒中急性期患者血脂、凝血功能、Hcy、CRP水平及日常生活水平的影响[J].吉林中医药,2011(8):763-765.
[7]祝美珍,王琳,吴志敏,等.清热化瘀Ⅱ号方治疗缺血性中风的临床观察[J].广西中医药,2011(5):7-8.
[8]祝美珍,肖健,肖艳芬,等.清热化瘀Ⅱ号方对急性脑梗死患者神经功能及全血ICAM-1、CD62P表达的影响[J].广西医科大学学报,2011(4):546-548.
[9]周靖,邓志,代雷.清热化瘀Ⅱ号治疗缺血性中风的疗效及对神经功能缺损评分和中医证候评分的影响研究[J].世界中医药,2014(2):186-187,192.
[10]龙华君,周珂,胡国恒,等.清热化瘀颗粒对脑梗死伴颈动脉粥样硬化斑块的影响[J].中国中医急症,2010(6):908,933.
[11]祝美珍.清热化瘀Ⅱ号方对急性脑缺血损伤NF-K Bp65蛋白及其关键靶因子表达的影响[D].长沙:湖南中医药大学,2008.
[12]李金辉,李桂凤.活血化瘀清热通腑法治疗急性脑出血疗效观察[J].中国中医急症,2005(2):110-111.
[13]胡跃强,胡国恒,王行宽,等.清热化瘀颗粒治疗急性脑梗塞临床观察[J].辽宁中医杂志,2004,32(2):120-121.
[14]胡国恒,吴云虎.清热化瘀颗粒治疗急性缺血性中风的临床研究[J].山东中医药大学学报,2004(1):31-33.
[15]林卿.清热活血化瘀法治疗高血压性脑出血疗效观察附:132例病例报告[J].成都中医药大学学报,2001(3):52-53.
[16]汪庭龙.清热化瘀方对急性缺血性中风的临床疗效及对血清NSE的影响[D].南宁:广西中医药大学,2016.
[17]胡跃强,唐农.清热化瘀方对脑缺血预处理大鼠ATF4、Caspase-12表达的影响[J].时珍国医国药,2012(8):1849-1851.