Liu Hong-Jie, He Tao-Zhi, Zhang Jiong-Lu, Wu Qian, Tan Li-Juan, Liu Dong-Dong
College of Traditional Chinese Medicine, Ji'nan University Guangzhou 510632, China.
Zhongguo Zhong Yao Za Zhi. 2020 Dec;45(24):6043-6052. doi: 10.19540/j.cnki.cjcmm.20200717.501.
To systematically evaluate the efficacy of traditional Chinese medicine(TCM) compounds combined with levodopa medicine in the treatment of Parkinson's disease(PD), and screen basic herbs to provide certain evidence-based medical proof and program for better guidance on clinical drug use. Six databases were searched to screen out the randomized controlled trial on the TCM compounds combined with levodopa medicine in the treatment of PD. Literature quality of the included studies was evaluated by improved Jadad rating scale, and the Meta-analysis was performed by RevMan 5.3 software. After the data of the basic TCM compounds involved were sorted out, the strong association rules were found by using Apriori algorithm of SPSS Modeler 18.0 software, and then the basic herbs for the treatment of PD could be picked out. A total of 20 studies were eventually included, involving 1 784 patients. Ten studies were of high-quality literature, Jadad score≥4 points. Meta-analysis showed that efficacy of TCM combined with levodopa medicine was better than levodopa medicine alone in lowering Unified Parkinson's Disease Rating Scale(UPDRS) score: UPDRS Ⅰ(MD=-0.43, 95%CI[-0.62,-0.24], P<0.000 1), UPDRS Ⅱ(MD=-2.72, 95%CI[-3.24,-2.21], P<0.000 01), UPDRS Ⅲ(MD =-1.97, 95%CI[-2.69,-1.25], P<0.000 01), UPDRS Ⅳ(MD=-0.28, 95%CI[-0.46,-0.11], P=0.002). And the improvement in UPDRS score reduction rate of TCM combined with levodopa medicine was better than that in levodopa medicine alone: effective rate(OR=4.81, 95%CI[3.50, 6.62], P<0.000 01). Data mining results showed that the basic prescription for treating PD consisted of Paeoniae Radix Alba-Rehmanniae Radix Praeparata-Gastrodiae Rhizoma in general. According to each part of UPDRS, the basic prescription for treating mentation, behavior and mood(UPDRS Ⅰ) consists of Paeoniae Radix Alba-Rehmanniae Radix Praeparata-Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle, Among which Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle might have unique efficacy. The basic prescriptions for treating UPDRS Ⅱ and UPDRS Ⅲ consisted of Paeoniae Radix Alba-Rehmanniae Radix Praeparata, or Chuanxiong Rhizoma-Angelicae Sinensis Radix(two drug combinations). However, in the treatment of UPDRS Ⅳ, the drugs were scattered. But due to the limitations in the quantity and quality of clinical studies, the results obtained still need further research and clinical confirmation of its efficacy.
系统评价中药复方联合左旋多巴类药物治疗帕金森病（PD）的疗效，筛选核心药物，为临床用药提供循证医学依据和方案。检索6个数据库，筛选出中药复方联合左旋多巴类药物治疗PD的随机对照试验。采用改良Jadad评分量表评价纳入研究的文献质量，并用RevMan 5.3软件进行Meta分析。整理纳入研究中涉及的中药核心药物数据，运用SPSS Modeler 18.0软件的Apriori算法挖掘强关联规则，筛选出治疗PD的核心药物。最终纳入20项研究，共1 784例患者。其中高质量文献10篇，Jadad评分≥4分。Meta分析结果显示：中药联合左旋多巴类药物在降低帕金森病统一评分量表（UPDRS）评分方面优于单用左旋多巴类药物，其中UPDRSⅠ（MD=-0.43，95%CI[-0.62，-0.24]，P<0.000 1）、UPDRSⅡ（MD=-2.72，95%CI[-3.24，-2.21]，P<0.000 01）、UPDRSⅢ（MD =-1.97，95%CI[-2.69，-1.25]，P<0.000 01）、UPDRSⅣ（MD=-0.28，95%CI[-0.46，-0.11]，P=0.002）；且在提高UPDRS评分降低率方面，中药联合左旋多巴类药物亦优于单用左旋多巴类药物，有效率（OR=4.81，95%CI[3.50，6.62]，P<0.000 01）。数据挖掘结果显示，治疗PD的核心方剂总体为白芍-熟地黄-天麻。按UPDRS各部分分析，治疗精神、行为和情绪（UPDRSⅠ）的核心方剂为白芍-熟地黄-蜜甘草，其中蜜甘草可能具有独特疗效。治疗UPDRSⅡ和UPDRSⅢ的核心方剂为白芍-熟地黄或川芎-当归（两药组合）。而治疗UPDRSⅣ时，用药较为分散。但由于临床研究数量和质量的限制，所得结果仍需进一步研究及临床疗效验证。
