Chinese Medicine for Alzheimer's Disease: A Meta-Analysis of Randomized Controlled Trials

Objective: To evaluate the efficacy of oral Chinese medicine(CM) in comparison with donepezil, a cholinesterase inhibitor(ChEI), for the treatment of Alzheimer's disease(AD). Methods: Randomized controlled trials(RCTs) have been searched, and the effect of CM compared with donepezil in AD has been investigated. An electronic search of MEDLINE, Excerpta Medica Database(EMBASE), Cochrane Library, Chinese Biological Medicine Database(CBMdisc), and China National Knowledge Infrastructure(CNKI) to identify articles in English and Chinese from the inception of the database until October 18, 2015. A modified Jadad score(7-points) to judge the methodological quality of studies, comprehensive meta-analysis was performed with Cochrane Collaboration Revman 5.3. Dichotomous data were analyzed by relative risk(RR) with a 95% confidence interval(CI), while continuous variables were analyzed by using mean differences(MD) with 95% CI for effect size. Results: Six studies involving 596 AD patients through Jadad assessment with low bias were included in the meta-analysis. No significant difference was observed in cognitive improvement and daily abilities of patients using the Mini Mental State Examination(MMSE)(MD: 0.69, 95% CI: –0.17 to 1.56) and Activities of Daily Living(ADL) scale(MD: 0.94, 95% CI: –1.54 to 3.43). There were no significant differences in status of illness or MD for mild-moderate AD patients at 24 weeks(MD: 0.62, 95% CI: –2.99 to 4.23) and 48 weeks(MD: –0.73, 95% CI: –5.02 to 3.56). Severe AD patients were also assessed at 24 weeks(MD: 3.13, 95% CI: –6.92 to 13.18) and 48 weeks(MD: 4.23, 95% CI: –6.38 to 14.84). Furthermore, compared with donepezil, Xin(Heart)-regulating CM and Shen(Kidney)-tonifying groups were observed(MD: –1.50, 95% CI: –3.08 to 0.08; MD: –1.92, 95% CI: –3.50 to –0.33; respectively). CM had fewer side effects in AD patients. Conclusion: Compared with donepezil, oral CM showed no significant difference in effectiveness in AD patients, and more evidence is needed to verify the findings.     

ω-3多不饱和脂肪酸辅助治疗溃疡性结肠炎的疗效及其机制研究

目的 观察ω-3多不饱和脂肪酸(ω-3PUFAs)辅助治疗溃疡性结肠炎(UC)的临床疗效及对外周血Th17/Treg细胞平衡和细胞因子IL-10、IL-17水平的影响。 方法 采用前瞻性随机对照研究,选择2014年1月-2016年12月就诊于丽水市中心医院的UC患者共50例,采用随机数字表法分为2组。对照组25例,给予美沙拉嗪1 g口服,4次/d;观察组25例,在对照组基础上加用ω3-PUFAs 100 ml 静滴,1次/d。其他非特异治疗措施2组相同,疗程均为1周。分别于治疗前后采用ELISA法检测血清IL-10、IL-17的表达水平,采用流式细胞仪检测外周血Treg细胞和Th17细胞的比例。比较2组患者治疗后的临床有效率,治疗前后血清IL-10、IL-17水平、外周血Treg细胞和Th17细胞比例的差异。 结果 观察组临床症状改善总有效率(88.0%)明显优于对照组总有效率(68.0%),差异有统计学意义(P<0.05)。与同组治疗前比较,2组患者外周血中Treg细胞比例、IL-10的水平均明显升高,而Th17细胞比例和IL-17的水平均明显下降,差异均有统计学意义(均P<0.05)。与对照组比较,观察组外周血中Treg细胞比例、IL-10水平的升高更显著,而Th17细胞比例和IL-17水平的下降更显著,差异有统计学意义(P<0.05)。 结论 ω-3PUFAs辅助治疗UC具有良好的临床疗效,其作用机制可能与调节Treg/Th17细胞的平衡而缓解UC的炎症反应有关。      

参附注射液治疗心功能不全随机对照试验研究

目的:观察参附注射液治疗心功能不全的临床效果。方法:120例慢性心功能不全患者被随机分为参附注射液治疗组(观察组,n=60)和丹参注射液治疗组(对照组,n=60)。比较两组疗效。结果:观察组治疗总有效率为93.3%,对照组为56.7%,差异有统计学意义(P<0.05)。结论:参附注射液辅助治疗慢性心功能不全疗效肯定,值得临床推广使用。     

头针治疗帕金森病：一项随机对照试验的系统评价

Objective: To evaluate the effectiveness of scalp acupuncture (SA), a modern acupuncture technique specialized to neurological disorders, in managing motor function and symptoms for Parkinson''s disease (PD) patients. Methods: Two independent reviewers extracted data from all of the randomized clinical trials (RCTs) that assessed the efficacy of SA for PD compared with conventional therapies (CTs). Sixteen electronic databases were searched. The risk of bias was appraised with the Cochrane Collaboration tool, and the reporting of the included studies was evaluated by the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist and the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines. Results: In total, 4 RCTs met the inclusion criteria. As assessed by the Unified PD Rating Scale (UPDRS), 2 RCTs showed that SA combined with CTs proved superior to CTs alone [60 cases; weighted mean difference, –3.94; 95% confidence interval (CI), –6.05 to –1.84, P=0.01; I2=0%]. Based on the Webster scale, however, 3 RCTs showed no superior effect of SA when combined with CTs with high heterogeneity (154 cases; risk ratio, 1.29; 95% CI, 0.79 to 2.12, P=0.30; I2=84%). The Cochrane risk of bias, adherence to the CONSORT and the STRICTA checklist showed that the quality of all the included RCTs was generally low. Conclusions: The result of our systematic review and meta-analysis suggested that the effectiveness of SA for PD is promising, however, the evidence is not convincing. A sham-controlled RCT design that adheres to the CONSORT and STRICTA guidelines to overcome methodological weakness and that includes a large sample size is strongly recommended to confirm the precise effect of SA on PD.     

Conventional Acupuncture for Cardiac Arrhythmia: A Systematic Review of Randomized Controlled Trials

Objective:To exam the effect and safety of conventional acupuncture(CA) on cardiac arrhythmia.Methods:Nine medical databases were searched until February 2016 for randomized controlled trials.Heterogeneity was measured by Cochran Q test.Meta-analysis was conducted if I2 was less than 85% and the characteristics of included trials were similar.Results:Nine qualified studies involving 638 patients were included.Only 1 study had definitely low risk of bias,while 7 trials were rated as unclear and 1 as high.Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation(Af) and atrial flutter(AF) [relative risk(RR):1.09;95% confidence interval(CI):0.79–1.49;P=0.61;I2=61%,P=0.11].However,1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment,and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study,as well as the response rate in CA plus deslanoside group by another study.Meta-analysis of CA plus anti-arrhythmia drug(AAD) was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat(VPB) patients(RR,1.19,95% CI:1.05–1.34;P=0.005;I2=13%,P=0.32),and an improvement in quality-of-life score(QOLS) of VPB also showed in 1 individual study.Besides,a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients(MD –21.84 [–27.21,–16.47]) and lower adverse events of CA alone were reported than amiodarone.Conclusions:CA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia,especially in VPB and Af patients,which mainly based on a pooled estimate and result from 1 study with higher methodological quality.However,we could not reach a robust conclusion due to low quality of overall evidence.     

Acupuncture Treatment for Post-Stroke Dysphagia: An Update Meta-Analysis of Randomized Controlled Trials

Objective

To explore the effectiveness and safety of acupuncture in patients with post-stroke dysphagia by an update meta-analysis.

Methods

Potentially eligible RCTs aimed to evaluate the effects of acupuncture vs. non-acupuncture treatments, such as rehabilitation training or routine medication on the swallowing difficulty after stroke were searched from PubMed, Cochrane Library, China National Knowledge Infrastructure, and other database from the earliest record to June 2016. Patient demographics, regimens for acupuncture, type of controls, methods of randomization, and measurements of the clinical symptoms of dysphagia were retrieved. The relative risk (RR) and 95% confidence interval (CI) of effective rate of dysphagia was calculated after intervention performed following admission. Subgroup analyses and a metaregression analysis were performed to describe the heterogeneity.

Results

Twenty-nine RCTs comprising 2,190 patients were included. The included studies had a medium quality grade based on the Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) checklist. Acupuncture therapy provided a higher effective rate compared with nonacupuncture treatments [RR=1.33, 95% confidence interval (CI), 1.25 to 1.43]. Subgroup and meta-regression analyses suggested that acupuncture intensity and measurement method were main sources of heterogeneity and resulted in a significant difference for pooled effect size. No severe adverse events were documented in these RCTs.

Conclusions

Our meta-analysis provides a new evidence supporting the efficacy and safety of acupuncture in treatment to post-stroke dysphagia in short-term compared with rehabilitation or medication. More high-quality and large-scale research studies are needed.

     

针灸治疗原发性痛经随机对照试验的腧穴运用特点的文献探讨

目的:探讨国内近年来针灸治疗原发性痛经的临床随机对照试验的腧穴选穴规律。方法:搜索近5年针灸治疗原发性痛经的临床随机对照相关文献,统计针灸治疗原发性痛经腧穴应用的频次分布情况。结果:共纳入57篇随机对照的针灸治疗原发性痛经相关文献,检索结果共涉及52个腧穴(十四经穴46个,经外奇穴5个,阿是穴1个)。应用频次最高的腧穴和经脉分别是关元穴、三阴交穴,任脉、脾经。腧穴分布部位较多为下腹部、下肢部及腰骶背部。结论:针灸治疗原发性痛经以关元、三阴交为主要腧穴,以任脉、足太阴脾经为主要经脉;针灸治疗原发性痛经多选取下腹部、下肢部及腰骶背部腧穴。     

消旋卡多曲辅助治疗轮状病毒肠炎随机对照研究的Meta分析

目的:利用循证医学方法探讨消旋卡多曲辅助治疗轮状病毒肠炎的安全性及有效性。方法:检索Pubmed、Web of Science、Embase、中国知网、维普及万方数据库,检索时间为2008年至2017年。利用Revman 5.3软件对纳入的文献进行Meta分析。结果:纳入26篇文献包含27个随机对照研究。Meta分析显示以消旋卡多曲作为辅助治疗的方案能提高有效率及显效率(P<0.01)。添加消旋卡多曲辅助治疗的方案可缩短症状缓解、呕吐缓解、大便次数及性状恢复时间,并可缩短治疗周期。安全性分析显示,在对症治疗的基础上增加消旋卡多曲并未增加不良反应(P=0.73)。结论:在对症治疗的基础上增加消旋卡多曲辅助治疗小儿轮状病毒肠炎安全、有效。     

甘露醇治疗面神经炎的随机对照文献Meta分析

目的:系统评价20%甘露醇注射液用于治疗面神经炎的疗效及安全性。方法:系统检索中国知网(CNKI)、万方期刊数据库、中国生物医学文献数据库、中文期刊数据库、超星发现系统、Pub Med数据库,检索时间均为2016年1月,获得符合纳入标准的随机或半随机临床对照试验,2位研究者独立采用Cochrane风险评价表,评价其风险偏倚,并提取所需资料,采用Rev Man 5.3软件进行Meta分析。结果:共纳入7篇文献,共计患者482例。Meta分析结果显示,甘露醇用于治疗面神经炎具有较好的疗效,临床总有效率RR=1.17,95%CI=1.10~1.25,(P<0.01),临床治愈率RR=1.58,95%CI=1.31~1.90,(P<0.01)。结论:20%甘露醇注射液用于治疗面神经炎具有一定的疗效,且相对安全,但因纳入文献数量有限且部分文献质量较差,上述结论需更多大样本、多中心、高质量的临床随机对照试验进一步验证。     

通心络胶囊治疗脑血管病随机对照试验的Meta分析

【目的】评价通心络胶囊治疗脑血管病的疗效与安全性。【方法】计算机检索中国期刊全文数据库(1996-2006年5月)、中国优秀博硕士学位论文全文数据库(1999-2006年5月)、MEDLINE(1996-2006年5月)、Cochrane图书馆,手工检索初步入选的所有文献,获取并评价通心络胶囊治疗脑血管病的随机对照试验(RCT)文献,然后分别采用SAS统计分析软件、RevMan 4.2软件进行Meta分析。【结果】共纳入37篇随机对照研究,3336例患者,其中通心络胶囊组1764例,对照组1572例。在总有效率方面,31个RCT的Meta分析结果显示,两组间差异有统计学意义(P<0.01);在神经功能缺损评分方面,按病种分类作亚组分析时,7个治疗急性脑梗塞的RCT研究显示,两组差异有统计学意义(P<0.05)。不良反应极少发生,未见明显毒副作用。【结论】现有的证据表明,通心络与其他药物比较,可以提高脑血管病患者的治疗总有效率。受纳入研究的质量和数量限制,通心络胶囊治疗脑血管病的疗效与安全性需要更多高质量的、大样本的、双盲的随机对照试验加以证实。     

褪黑素对非酒精性脂肪性肝病大鼠游离脂肪酸的影响

目的：研究褪黑素（MT）对大鼠非酒精性脂肪性肝病（NAFLD）的形成和游离脂肪酸（FFA）的影响,探讨MT防治NAFLD的可能机制.方法：将雄性Wistar大鼠随机分成对照组、模型组和MT低、中、高剂量组（MT1、MT2和MT3组）,每组10只.对照组给予普通饲料喂养,模型组和MT1、MT2及MT3组给予高脂饮食12周.MT各剂量组分别给予MT 2.5、5.0和10.0 mg·kg-1·d-1腹腔注射.12周末处死大鼠,进行肝脏病理学检查,检测大鼠血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血清及肝脏三酰甘油（TG）、总胆固醇（TC）和FFA水平.结果：大鼠高脂饮食12周成功复制NAFLD模型.与模型组比,MT各剂量组大鼠肝细胞脂肪变性有不同程度的改善;模型组血清ALT水平高于对照组（P＜0.05）,而TG低于对照组（P＜0.05）,模型组大鼠肝匀浆TC、TG亦均明显高于对照组（P＜0.01）.MT1组大鼠血清ALT水平高于对照组（P＜0.05）,MT1组和MT2组血清TG水平均低于对照组（P＜0.05）;MT1组肝匀浆TC及MT1组、MT2组与MT3组TG水平均明显高于对照组（P＜0.01）;MT3组肝匀浆TC水平明显低于模型组（P＜0.01）.模型组大鼠血清FFA水平明显高于对照组（P＜0.01）;与模型组比较,MT各剂量组血清FFA均降低（P＜0.05～P＜0.01）.模型组大鼠肝匀浆FFA水平明显高于对照组（P＜0.01）;MT2、MT3组肝匀浆FFA均明显低于模型组（P＜0.01）.结论：MT对NAFLD的形成有明显防治作用,且与剂量呈正相关,可能与MT降低FFA合成而改善氧化应激和抑制脂质过氧化等有关.     

Blood-Letting Therapy for Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: To evaluate the efficacy and safety of blood-letting therapy (BLT) in treatment of hypertension. Methods: A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials, Excerpt Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and Wanfang Database to identify randomized controlled trials (RCTs) in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs (BPAD) against placebo, no treatment or antihypertensive drugs. The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. The Review Manager 5.3 software was used for meta-analysis. Results: A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified. Compared with antihypertensive drugs, blood pressure was significantly reduced by BLT (RR=1.21, 95% CI: 1.01 to 1.44, P=0.03; heterogeneity: P=0.06, I2=60%) and BPAD (RR=1.25, 95% CI, 1.02 to 1.53, P=0.03; heterogeneity: P= 0.01, I2=71%). Moreover, a significant improvement in Chinese medicine syndrome by BLT (RR=1.32; 95% CI: 1.14 to 1.53, P=0.0002; heterogeneity: P=0.53, I2=0%) and BPAD (RR=1.47; 95% CI: 1.06 to 2.04, P=0.02; heterogeneity: P=0.13, I2=56%) was identified. The reported adverse effects were well tolerated. Conclusions: Although some positive findings were identified, no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. Further rigorously designed trials are warranted to confirm the results.     

Chinese Medicine for Idiopathic Parkinson's Disease: A Meta Analysis of Randomized Controlled Trials

Objective:To evaluate the efficacy of Chinese medicine(CM) adjunct to conventional medications for idiopathic Parkinson's disease(PD).Methods:Electronic English and Chinese databases including PubMed,Cochrane Library,Web of Science,Chinese Medical Current Contents,China National Knowledge Infrastructure,China Science and Technology Journal Database,Wanfang Med Database,and Traditional Chinese Medical Database System were used for key words searching in a highly sensitive search strategy.The extracted data was analyzed by the Review Manager 5.0.Results:Twelve trials involving 869 participants were included in the meta-analysis.Unified PD Rating Scale(UPDRS) I,Ⅱ,Ⅲ,Ⅳ scores and UPDRS Ⅰ-Ⅳ total scores were used to be the primary outcomes,Parkinson Disease Question-39(PDQ-39) and Scores of Chinese Medical Symptoms were the secondary outcomes.CM adjunct therapy had greater improvement in UPDRS Ⅰ[2 trials;standardized mean difference(SMD)-0.40,95%confidence interval(CI)-0.71 to-0.09;Z=2.49(P=0.01)],Ⅱ[5 trials;SMD-0.47,95%CI-0.69 to-0.25;Z=4.20(P0.01)],Ⅲ[5 trials;SMD-0.35,95%CI-0.57 to-0.13;Z=3.16(P=0.002)],Ⅳ scores[3 trials;SMD-0.32,95%CI-0.60 to-0.03;Z=2.17(P=0.03)],UPDRS Ⅰ-Ⅳ total scores[7 trials;SMD-0.36,95%CI-0.53 to-0.20;Z=4.24(P0.05)].PDQ-39 and Chinese medical symptoms compared to the conventional medication only.Conclusion:CM adjunct therapy has potential therapeutic benefits by decreasing UPDRS scores and reducing adverse effect.     

血清游离脂肪酸水平与冠状动脉病变的相关性

 目的 探讨血清游离脂肪酸水平与冠状动脉病变的关系。方法 选择169例(男性105例,女性64例)接受冠脉造影检查的心内科住院患者,年龄38~86岁,应用冠脉狭窄指数(coronary stenosis index,CSI)评价冠状动脉病变的严重程度。结果 (1) 169例研究对象中,115例(男性80例)经冠脉造影证实为冠心病(coronary artery disease,CAD)。男、女性的空腹及餐后2 h游离脂肪酸的差异无统计学意义(P＞0.05)。(2) 与非CAD患者(non CAD)相比,CAD组空腹游离脂肪酸及CSI评分明显升高(P＜0.05),而HDL c水平降低(P＜0.05)。(3) 单支病变组及多支病变组空腹游离脂肪酸水平均高于无病变组(P＜0.05),但餐后2 h游离脂肪酸水平无明显差异(P＞0.05)。(4) Logistic回归分析显示,校正其他传统因素后,空腹游离脂肪酸是CAD的独立影响因素。结论 血清空腹游离脂肪酸水平与冠状动脉病变相关。     

Oral Oxymatrine Preparation for Chronic Hepatitis B: A Systematic Review of Randomized Controlled Trials

Objective

To evaluate the efficacy and safety of oral oxymatrine preparation for the treatment of chronic hepatitis B (CHB).

Methods

Randomized controlled trials (RCTs) on oral oxymatrine preparation in treating patients with CHB were retrieved until October 2013 by searching PubMed, the Cochrane Library, Embase and four Chinese databases, irrespective of language and publication status. Data extraction and data analyses were conducted according to the Cochrane standards. The risk of bias for each included trials and the quality of evidence on pre-specified outcomes were assessed. The RevMan software was used for statistical analyses.

Results

Totally 52 RCTs enrolling 5,227 participants were included, of which 51 RCTs were included in meta-analyses. Oral oxymatrine preparation including oxymatrine capsule and oxymatrine tablet were associated with statistically significant effect on the clearance of hepatitis B virus (HBV) DNA, HBV surface antigen and HBV e antigen, and were beneficial to the normalization of serum alanine aminotransferase and aspartate aminotransferase. Nevertheless, the overall methodological quality and the quality of evidence in the included trials were poor. In addition, safety of oral oxymatrine preparation was not confirmed.

Conclusions

Oral oxymatrine preparation showed some potential benefits for patients with CHB. However, the overall quality of evidence was limited and the safety of oral oxymatrine preparation for CHB patients was still unproven. More high quality evidence from rigorously designed RCTs is warranted to support the clinical use of oral oxymatrine preparation for patients with CHB.