Zhang Xin, Liu Xue-Ting, Kang De-Ying
From the Department of Integrated Traditional Chinese and Western Medicine(XZ); and Department of Evidence-Based Medicine and Clinical Epidemiology (X-TL, D-YK), West China Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2016 Mar;95(12):e2986. doi: 10.1097/MD.0000000000002986.
The aim of the study is to conduct an overview of systematic reviews (SRs) to provide a contemporary review of the evidence for delivery of Traditional Chinese Patent Medicine (TCPMs) for patients with acute ischemic stroke.SRs were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ). We assessed the quality of the evidence of high methodological quality (an AMSTAR score ≥9 or an OQAQ score ≥7) for reported outcomes using the GRADE (the Grading of Recommendations Assessment, Development and Evaluation) approach.(1) Dan Shen agents: tiny trends toward the improvement in different neurological outcomes (RR = 1.16, 1.10, 1.23, 1.08, 1.12); (2) Mailuoning: a tiny trend toward improvement in the neurological outcome (RR = 1.18); (3) Ginkgo biloba: tiny trends toward improvement in the neurological outcome (RR = 1.18, MD = 0.81); (4) Dengzhanhua: a tiny trend toward an improvement in neurological (RR = 1.23); (5) Acanthopanax: a small positive (RR = 1.17, 1.31) result on neurological improvement reported; (6) Chuanxiong-type preparations: neurological functional improved (MD = 2.90);(7) Puerarin: no better effect on the rate of death or disability (OR = 0.81, 95% CI 0.35-1.87); (8) Milk vetch: no better effect on the rate of death (OR = 0.66, 95% CI: 0.11-2.83);(9) Qingkailing: rate of death reduced (OR = 0.66, 95% CI: 0.11-2.83). Limitations in the methodological quality of the RCTs, inconsistency and imprecision led to downgrading of the quality of the evidence, which varied by review and by outcome. Consequently, there are currently only weak evidences to support those TCPMs.The 9 TCPMs may be effective in the treatment of acute ischemic stroke, as the GRADE approach indicated a weak recommendation for those TCPMs' usage.
本研究旨在对系统评价（SRs）进行综述，以对急性缺血性中风患者使用中药专利药（TCPMs）的证据进行当代综述。使用多重系统评价评估（AMSTAR）工具和奥克斯曼-盖亚特综述质量评估问卷（OQAQ）对SRs的质量进行评估。我们使用GRADE（推荐分级评估、制定和评价）方法评估报告结局的高方法学质量证据（AMSTAR评分≥9或OQAQ评分≥7）的质量。（1）丹参制剂：不同神经学结局有微小改善趋势（RR = 1.16、1.10、1.23、1.08、1.12）；（2）脉络宁：神经学结局有微小改善趋势（RR = 1.18）；（3）银杏叶：神经学结局有微小改善趋势（RR = 1.18，MD = 0.81）；（4）灯盏花：神经学有微小改善趋势（RR = 1.23）；（5）刺五加：报告显示对神经学改善有小的阳性结果（RR = 1.17、1.31）；（6）川芎类制剂：神经功能改善（MD = 2.90）；（7）葛根素：对死亡或残疾率无更好效果（OR = 0.81，95%CI为0.35 - 1.87）；（8）黄芪：对死亡率无更好效果（OR = 0.66，95%CI：0.11 - 2.83）；（9）清开灵：死亡率降低（OR = 0.66，95%CI：0.11 - 2.83）。随机对照试验方法学质量的局限性、不一致性和不精确性导致证据质量降级，其因综述和结局而异。因此，目前仅有薄弱证据支持这些TCPMs。这9种TCPMs可能对急性缺血性中风有效，因为GRADE方法对这些TCPMs的使用给出了弱推荐。
