星蒌承气汤加减治疗脑卒中急性期的系统评价

目的 系统评价星蒌承气汤加减治疗脑卒中急性期的疗效性与安全性.方法 应用计算机、手工结合方式在全面检索中国学术期刊全文数据库、万方知识服务平台等数据库中进行文献检索,搜集1991 年-2014 年相关文献,纳入合格的随机对照文献后,按照CoChrane 协作网标准,应用Jadad 评分法给予质量评价,应用RevMan5.1 软件进行Meta 分析.结果 经筛选纳入19篇文献,共1 467 例,治疗组755 例,对照组712 例,各研究基线可比.应用Jadad 量表评价文章质量,1 篇试验得5 分属高质量文献,5 篇试验得3 分属中等质量文献,其余均低于3 分属低质量文献.Meta 分析结果显示：星蒌承气汤加减联合西药常规治疗在提高脑卒中病急性期总的临床疗效RR = 1.29,95% CI （1.22,1.37）]、降低神经功能缺损评分WMD= -4.29,95% CI （-6.13,- 2.45）]、降低大便症状积分WMD= -3.63,95%CI （-4.33,-2.93）]、降低中医证候积分WMD= -3.01,95%CI （-4.31,-1.7）]、提高日常生活活动能力WMD= 9.07,95%CI （5.46,12.67）]、降低高切血黏度WMD= -0.93,95% CI （-1.4,-0.46）]、低切血黏度WMD= -1.68,95%CI（-2.95,-0.4）]、纤维蛋白WMD= -0.5,95%CI （-0.96,-0.04）]方面均优于治疗组.在降低脑卒中病死率OR = 0.59,95%CI （0.26,1.34）,P = 0.21]及血CRPWMD= -0.66,95%CI （-2.08,0.76）,P = 0.36]方面无统计学意义.结论 目前拥有的数据表明,星蒌承气汤加减联合西药常规治疗脑卒中急性期的疗效是优于对照组的,但尚不认为其具有降低急性脑卒中病死率的作用.受纳入文献质量和数量的限制,仍然需要纳入更多高质量、多中心、大样本量,且应该经过严格设计的随机双盲对照试验支持临床疗效.

Systematic Assessment of Xinglou Chengqi Decoction for Treatment of Acute Stroke

Objective The objective was to systematically assess curative effect and security of Xinglou Chengqi decoction（XCD）for treatment of acute stroke.Methods The databases including China Journal Full Text Database （CJFD）and WanFangDatabase from 1991 to 2014 were retrieved for collecting the randomized controlled trials literature that met inclusion criteria.Thequality of collected literature was evaluated according to the RevMan 5.1 software,and Jadad scoring method recommended by Co- chrane Collaboration was used in meta analysis.Results There were 19 literature included 1 467 cases,there were 755 cases intreatment group （treating with XCD and its additional and subtractive recipes combining western medicine）and 712 in control group（treating only with western medicine）.The baseline data was comparability.Based on Jadad scale scoring,there were lots of lowquality literatures getting under 3 scores,except 1 high quality literature getting 5 scores and 5 middle quality literatures getting 3scores.This Meta analysis result showed that treatment group was better than the control group in improving total clinical curativeeffectRR = 1.29,95% CI （1.22,1.37）],decreasing NIHSS WMD= -4.29,95% CI （-6.13,-2.45）],reducing TCM syndromeintegrals WMD= -3.01,95% CI （-4.31,-1.7）],reducing stool syndrome integrals WMD= -3.63,95% CI （-4.33,-2.93）], improving activity of daily living WMD= 9.07,95% CI （5.46,12.67）],reducing high plasma viscosity WMD= -0.93,95% CI （-1.4,-0.46）],reducing low plasma viscosity WMD= -1.68,95% CI（- 2.95,- 0.40）],reducing fibrinogen WMD= -0.5,95% CI（-0.96,-0.04）].In the treatment group the case mortality OR = 0.59,95% CI （0.26,1.34）,P = 0.21]and CRPWMD= -0.66,95% CI（-2.08,0.76）,P = 0.36]had no statistical meaning.Conclusion The current evidence showed treatment group hasd better effec- tiveness when compared with control group,but there was not enough evidence to support it could reduce the case mortality.Be- cause of the limitation of literature