Cai Yiyi, Zhang Claire Shuiqing, Liu Shaonan, Wen Zehuai, Zhang Anthony Lin, Guo Xinfeng, Xue Charlie Changli, Lu Chuanjian
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
Front Pharmacol. 2019 Jun 27;10:734. doi: 10.3389/fphar.2019.00734. eCollection 2019.
Treatment for post-stroke spasticity (PSS) remains a major challenge in clinical practice. Chinese herbal medicine (CHM) is often administered to assist in routine care (RC) in the treatment of PSS, with increasing numbers of clinical research and preclinical studies suggesting that it has potential benefits. Therefore, we conducted a systematic review and meta-analysis to evaluate the add-on effects and safety of CHM for PSS. Five English and four Chinese databases were searched from their respective inception to 28 February 2018. We included randomized controlled trials that evaluated the add-on effects of CHM for PSS, based on changes in the scores of the (Modified) Ashworth Scale (AS or MAS), Fugl-Meyer Assessment of Sensorimotor Recovery (FMA), and Barthel Index (BI). Thirty-five trials involving 2,457 patients were included. For upper-limb AS or MAS, the estimated add-on effects of CHM to RC were significantly better when using oral (SMD -1.79, 95% CI: -3.00 to -0.57) or topical CHM (SMD -1.06, 95% CI: -1.40 to -0.72). For lower-limb AS or MAS, significant add-on benefits to RC were also detected (SMD -1.01, 95% CI: -1.43 to -0.59 and SMD -1.16, 95% CI: -1.83 to -0.49) using oral and topical CHM, respectively. For FMA and BI, better results were detected when adding CHM to RC, except for the subgroup of oral CHM for upper-limb FMA. Ten of the 35 included studies reported safety information, with two of them mentioning two mild adverse events. Noting the quality concerns of the included trials, this review suggests that CHM appears to be a well-tolerated therapy for patients with PSS, and the potential add-on effects of CHM in reducing spasticity and improving the daily activities of patients with PSS require further rigorous assessment.
中风后痉挛（PSS）的治疗仍是临床实践中的一项重大挑战。中药（CHM）常用于辅助中风后痉挛的常规护理（RC），越来越多的临床研究和临床前研究表明其具有潜在益处。因此，我们进行了一项系统评价和荟萃分析，以评估中药对中风后痉挛的附加效果及安全性。检索了5个英文数据库和4个中文数据库，检索时间从各数据库建库至2018年2月28日。我们纳入了基于（改良）Ashworth量表（AS或MAS）、Fugl-Meyer运动功能评定量表（FMA）和Barthel指数（BI）评分变化，评估中药对中风后痉挛附加效果的随机对照试验。共纳入35项试验，涉及2457例患者。对于上肢AS或MAS，口服中药（标准化均数差SMD -1.79，95%置信区间：-3.00至-0.57）或外用中药（SMD -1.06，95%置信区间：-1.40至-0.72）时，中药联合常规护理的附加效果显著更好。对于下肢AS或MAS，口服和外用中药联合常规护理也分别显示出显著的附加益处（SMD -1.01，95%置信区间：-1.43至-0.59；SMD -1.16，95%置信区间：-1.83至-0.49）。对于FMA和BI，中药联合常规护理能取得更好的结果，但上肢FMA口服中药亚组除外。35项纳入研究中有10项报告了安全性信息，其中2项提及了2例轻度不良事件。鉴于纳入试验的质量问题，本评价表明中药似乎是中风后痉挛患者耐受性良好的一种治疗方法，中药在减轻中风后痉挛患者痉挛程度和改善日常活动方面的潜在附加效果需要进一步严格评估。
