Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Medicine (Baltimore). 2021 Jan 8;100(1):e24173. doi: 10.1097/MD.0000000000024173.
Whether the addition of Chinese herbal medicine (CHM) in routine western medicines for post-stroke depression yields additional therapeutic effects still remains to be controversial. This study aimed to assess the efficacy and safety of combination of CHM with routine western medicines versus routine western medicines alone in patients with post-stroke depression (PSD).
Electronic databases such as PubMed, EmBase, Cochrane library, and China National Knowledge Infrastructure were systematically searched from inception till October 2019. Studies designed as randomized controlled trials (RCTs) and that investigated the therapeutic effects of CHM plus routine western medicines (CHM group) versus routine western medicines alone (control group) in PSD patients were eligible. The relative risk (RR) and weighted mean difference (WMD) with 95% confidence interval (CI) were used to assess the categories and continuous data using random-effects model. Software STATA was applied to perform statistical analysis (Version 10.0; StataCorp, TX,).
A total of 18 RCTs involving a total of 1,367 PSD patients were selected for final analysis. The effective rate in CHM group was significantly higher than that in control group (RR: 1.18; 95%CI: 1.12-1.24; P < .001). Moreover, patients in CHM group showed association with lower Hamilton Depression Rating Scale (WMD: -3.17; 95%CI: -4.12 to -2.22; P < .001) and Scandinavian Stroke Scale (WMD: -3.84; 95%CI: -5.73 to -1.96; P < .001) than those in control group. Furthermore, patients in CHM were associated with high level of Barthel Index than those in control group (WMD: 11.06; 95%CI: 4.01 to 18.10; P = .002). Finally, patients in CHM group had lower risk of gastrointestinal (RR: 0.49; 95%CI: 0.31-0.77; P = .002) and neurological (RR: 0.50; 95%CI: 0.33-0.75; P = .001) adverse events than those in control group.
The study findings revealed that addition of CHM to routine therapies could improve the therapeutic effects and reduce gastrointestinal or neurological adverse events.
中药（CHM）联合常规西药治疗中风后抑郁症是否能带来额外的疗效仍存在争议。本研究旨在评估 CHM 联合常规西药与单纯常规西药治疗中风后抑郁症（PSD）患者的疗效和安全性。
系统检索 PubMed、EmBase、Cochrane 图书馆和中国知网等电子数据库，检索时限为建库至 2019 年 10 月。纳入设计为随机对照试验（RCT）且研究 CHM 联合常规西药（CHM 组）与单纯常规西药（对照组）治疗 PSD 患者的疗效的研究。采用随机效应模型对分类资料和连续资料分别进行相对危险度（RR）和加权均数差（WMD）及其 95%置信区间（CI）的计算。采用 STATA 软件（版本 10.0；StataCorp，TX，USA）进行统计学分析。
共纳入 18 项 RCT，共计 1367 例 PSD 患者最终纳入分析。CHM 组的有效率明显高于对照组（RR：1.18；95%CI：1.12-1.24；P＜0.001）。此外，与对照组相比，CHM 组患者的汉密尔顿抑郁量表（WMD：-3.17；95%CI：-4.12 至-2.22；P＜0.001）和斯堪的纳维亚卒中量表（WMD：-3.84；95%CI：-5.73 至-1.96；P＜0.001）评分更低。而且，CHM 组患者的巴氏指数（WMD：11.06；95%CI：4.01 至 18.10；P=0.002）高于对照组。最后，CHM 组患者发生胃肠道（RR：0.49；95%CI：0.31-0.77；P=0.002）和神经（RR：0.50；95%CI：0.33-0.75；P=0.001）不良事件的风险低于对照组。
本研究结果表明，CHM 联合常规治疗可提高疗效，并降低胃肠道或神经不良事件的发生风险。
