Yang Wen-Ting, Zheng Xia-Wei, Chen Shuang, Shan Chun-Shuo, Xu Qing-Qing, Zhu Jia-Zhen, Bao Xiao-Yi, Lin Yan, Zheng Guo-Qing, Wang Yan
Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 32500, China.
Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Biochem Pharmacol. 2017 Oct 1;141:143-155. doi: 10.1016/j.bcp.2017.07.002. Epub 2017 Jul 8.
Currently, there is lack of cure or disease-modifying treatment for Alzheimer's disease (AD). Chinese herbal medicine (CHM) is purported to ameliorate AD progression, perhaps by promoting hippocampal neurogenesis. Here, we conducted an updated systematic review to investigate the efficacy and safety of CHM for AD based on high-quality randomized controlled trials (RCTs) and reviewed its possible mechanisms of neurogenesis according to animal-based researches. Twenty eligible studies with 1767 subjects were identified in eight database searches from inception to February 2017. The studies investigated the CHM versus placebo (n=3), CHM versus donepezil (n=9 with 10 comparisons), CHM plus donepezil versus donepezil (n=3), CHM versus a basic treatment (n=3), and CHM plus basic treatment versus basic treatment (n=2). Adverse events were reported in 11 studies, analyzed but not observed in 3 studies, and not analyzed in 6 studies. The main findings of present study are that CHM as adjuvant therapy exerted an additive anti-AD benefit, whereas the efficacy of CHM as a monotherapy was inconclusive. Additionally, CHMs were generally safe and well tolerated in AD patients. Active molecules in frequent constituents of CHMs can alter multiple critical signaling pathways regulating neurogenesis. Thus, the present evidence supports, to a limited extent, the conclusion that CHM can be recommended for routine use in AD patients and its possible mechanism enhances adult hippocampal neurogenesis through activating the multi-signal pathways.
目前，尚无治愈或改变阿尔茨海默病（AD）病程的治疗方法。据推测，中药（CHM）或许可通过促进海马神经发生来改善AD的病情进展。在此，我们进行了一项更新的系统评价，以基于高质量随机对照试验（RCT）研究CHM治疗AD的疗效和安全性，并根据动物研究回顾其可能的神经发生机制。从建库至2017年2月，在8个数据库检索中确定了20项符合条件的研究，涉及1767名受试者。这些研究比较了CHM与安慰剂（n = 3）、CHM与多奈哌齐（n = 9，10项比较）、CHM加用多奈哌齐与多奈哌齐（n = 3）、CHM与基础治疗（n = 3）以及CHM加用基础治疗与基础治疗（n = 2）。11项研究报告了不良事件，3项研究进行了分析但未观察到不良事件，6项研究未进行分析。本研究的主要发现是，CHM作为辅助治疗具有额外的抗AD益处，而CHM作为单一疗法的疗效尚无定论。此外，CHM在AD患者中总体安全且耐受性良好。CHM常见成分中的活性分子可改变多个调节神经发生的关键信号通路。因此，目前的证据在一定程度上支持以下结论：CHM可推荐用于AD患者的常规治疗，其可能的机制是通过激活多信号通路增强成年海马神经发生。
