桃红四物汤联合西医常规治疗缺血性脑卒中临床疗效Meta分析(1)
【摘 要】 目的：系统评价桃红四物汤联合西医常规治疗缺血性脑卒中的临床疗效。方法：计算机检索CNKI、VIP、PubMed、EMBase等数据库，筛选从建库至2020年1月的桃红四物汤联合西医常规治疗缺血性卒中的随机对照试验(randomized controlled trial，RCT)，并运用RevMan 5.3软件对纳入研究进行Meta分析。结果：入选13篇文献，1274例患者。结果显示与西医常规组比较，联合组能显著提高临床有效率、改善神经功能缺损评分、降低血清炎性指标，差异具有统计学意义。结论：桃红四物汤联合西医常规治疗缺血性脑卒中优于单纯采用西医常规方法，但仍需更多大样本和设计严谨的RCT予以验证。
【关键词】 桃红四物汤;缺血性脑卒中;随机对照试验;Meta分析
【中图分类号】R255.2 【文献标志码】 A【文章编号】1007-8517(2020)14-0051-06
A Meta-analysis of Clinical Effects of Taohong Siwu Decoction Combined with Conventional Western Medicine in the Treatment of Ischemic Stroke
LI Xiangguo LEI Minghao HUANG Debin GAN Wenping HU Zehua*
Department of Medicine， Hubei Minzu University，Enshi 445000， China
Abstract：Objective For the sake of systematically evaluating the clinical efficacy of Taohong Siwu Decoction combined with conventional western medicine in the treatment of ischemic stroke.Methods The computer searched CNKI， VIP， PubMed， EMbase and other databases， and screened a randomized controlled trial (RCT) of Taohong Siwu Decoction combined with conventional Western medicine for the treatment of ischemic stroke from the establishment of the database to January 2020， and used RevMan5. 3 software performs meta-analysis on the included studies.Results Thirteen literatures were included in 1274 patients. The consequences revealed that compared with the western medicine conventional group， the combined group could significantly improve clinical effectiveness， improve neurological deficit scores， and reduce serum inflammatory indexes. The differences are statistically significant.Conclusion Taohong Siwu Decoction combined with conventional western medicine for the treatment of ischemic stroke is more splendid than conventional western medicine alone. Nevertheless， more large samples and rigorous design of RCT are still needed for verification.
Keywords：Taohong Siwu Decoction; Ischemic Stroke; Randomized Controlled Trial; Meta-analysis
缺血性脑卒中(Cerebral Ischemic Stroke)是指因动脉粥样硬化、心源性栓子等原因引起的脑部血管急、慢性狭窄或闭塞所致的脑细胞坏死，而出现以昏仆、偏瘫、口眼歪斜等為主要症状的疾病。在脑血管疾病中，缺血性脑卒中为临床多见的一类疾病，占全部脑卒中的70%～80%[1]，以高患病、高复发、高致死和高致残率为特征，对患者的身心健康造成严重影响。缺血性脑卒中可归于中医“中风病”，中医学认为本病以脏腑气血阴阳化生不足，产生痰、瘀等病理因素，两者互为因果，当遇机体气机失调超过人体正常调节能力而发病[2]。在缺血性脑卒中的中医学病机中，以气血阴阳不足、瘀阻脑络较为常见[3]。桃红四物汤在临床上对中医辨证为血虚血瘀症应用较多，具有活血补血、祛瘀行气的功效。近年来桃红四物汤联合西药治疗缺血性卒中的临床研究越来越多，尚无此方面研究的系统评价。本研究通过检索中外数据库，收集桃红四物汤对缺血性脑卒中的RTC，定量合成各个结果予以系统评价，为临床科学运用提供循证依据。
1 资料与方法
1.1 纳入标准 ①研究类型：随机对照试验。文种不限。②研究对象：符合疾病相关诊断标准[4-5]，经MRI/CT确认的病例。③干预措施：西医常规组采用抗血小板聚集、降纤、脑保护剂、降颅压等。联合组在西医常规组的治疗方案上加用桃红四物汤加减治疗，但药物的增减不可改变原方主治功效。④结局指标：包括临床总有效率：(痊愈+显效+有效)/总例数×100%、神经功能缺损评分(NIHSS评分[6]包括意识情况、上、下肢体运动功能、肢体协调等11个评定项目，评分越高表示神经缺损越严重;CSS评分[7]包括意识、水平凝视、上下肢肌力等8项进行评分，评分越低，表明神经功能缺损越轻)、血清指标(TNF-α和CRP表达水平)和不良反应等。, 百拇医药(李相国 雷明豪 黄德斌 甘文平 胡泽华)
【关键词】 桃红四物汤;缺血性脑卒中;随机对照试验;Meta分析
【中图分类号】R255.2 【文献标志码】 A【文章编号】1007-8517(2020)14-0051-06
A Meta-analysis of Clinical Effects of Taohong Siwu Decoction Combined with Conventional Western Medicine in the Treatment of Ischemic Stroke
LI Xiangguo LEI Minghao HUANG Debin GAN Wenping HU Zehua*
Department of Medicine， Hubei Minzu University，Enshi 445000， China
Abstract：Objective For the sake of systematically evaluating the clinical efficacy of Taohong Siwu Decoction combined with conventional western medicine in the treatment of ischemic stroke.Methods The computer searched CNKI， VIP， PubMed， EMbase and other databases， and screened a randomized controlled trial (RCT) of Taohong Siwu Decoction combined with conventional Western medicine for the treatment of ischemic stroke from the establishment of the database to January 2020， and used RevMan5. 3 software performs meta-analysis on the included studies.Results Thirteen literatures were included in 1274 patients. The consequences revealed that compared with the western medicine conventional group， the combined group could significantly improve clinical effectiveness， improve neurological deficit scores， and reduce serum inflammatory indexes. The differences are statistically significant.Conclusion Taohong Siwu Decoction combined with conventional western medicine for the treatment of ischemic stroke is more splendid than conventional western medicine alone. Nevertheless， more large samples and rigorous design of RCT are still needed for verification.
Keywords：Taohong Siwu Decoction; Ischemic Stroke; Randomized Controlled Trial; Meta-analysis
缺血性脑卒中(Cerebral Ischemic Stroke)是指因动脉粥样硬化、心源性栓子等原因引起的脑部血管急、慢性狭窄或闭塞所致的脑细胞坏死，而出现以昏仆、偏瘫、口眼歪斜等為主要症状的疾病。在脑血管疾病中，缺血性脑卒中为临床多见的一类疾病，占全部脑卒中的70%～80%[1]，以高患病、高复发、高致死和高致残率为特征，对患者的身心健康造成严重影响。缺血性脑卒中可归于中医“中风病”，中医学认为本病以脏腑气血阴阳化生不足，产生痰、瘀等病理因素，两者互为因果，当遇机体气机失调超过人体正常调节能力而发病[2]。在缺血性脑卒中的中医学病机中，以气血阴阳不足、瘀阻脑络较为常见[3]。桃红四物汤在临床上对中医辨证为血虚血瘀症应用较多，具有活血补血、祛瘀行气的功效。近年来桃红四物汤联合西药治疗缺血性卒中的临床研究越来越多，尚无此方面研究的系统评价。本研究通过检索中外数据库，收集桃红四物汤对缺血性脑卒中的RTC，定量合成各个结果予以系统评价，为临床科学运用提供循证依据。
1 资料与方法
1.1 纳入标准 ①研究类型：随机对照试验。文种不限。②研究对象：符合疾病相关诊断标准[4-5]，经MRI/CT确认的病例。③干预措施：西医常规组采用抗血小板聚集、降纤、脑保护剂、降颅压等。联合组在西医常规组的治疗方案上加用桃红四物汤加减治疗，但药物的增减不可改变原方主治功效。④结局指标：包括临床总有效率：(痊愈+显效+有效)/总例数×100%、神经功能缺损评分(NIHSS评分[6]包括意识情况、上、下肢体运动功能、肢体协调等11个评定项目，评分越高表示神经缺损越严重;CSS评分[7]包括意识、水平凝视、上下肢肌力等8项进行评分，评分越低，表明神经功能缺损越轻)、血清指标(TNF-α和CRP表达水平)和不良反应等。, 百拇医药(李相国 雷明豪 黄德斌 甘文平 胡泽华)