Dept. of Environmental Engineering, Hoseo University, Asan, South Korea.
Dept. of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, Asan, South Korea.
Chin J Nat Med. 2021 May;19(5):339-350. doi: 10.1016/S1875-5364(21)60035-3.
The management of post-stroke complications plays an important role in the quality of life. Di-Tan Decoction (DTD; ) is a widely used traditional Chinese medicine. This study incorporated systematic review and meta-analysis to evaluate the efficacy of DTD in post-stroke neurological disorders. Randomized clinical trials (RCTs) were searched from English, Chinese and Korean electronic medical databases, by including the keywords "Di-Tan Tang", "Di-Tan Decoction", "Scour Phlegm Decoction", "stroke", and "RCT. Each RCT included control (placebo, conventional therapy, or Western medicine) and experimental (DTD treatment) groups. For patients inflicted with stroke for 1-6 weeks, the outcomes of post-stroke neurological disorders were measured by scales for post-stroke symptoms and were classified as "completely healed", "markedly effective", "effective" and "ineffective". Totally, 11 RCTs (n = 490 controls and n = 502 DTD subjects) were selected from 210 articles identified in the initial search. A meta-analysis of evaluation criteria in post-stroke symptoms revealed that the overall odds ratio (ORs) for alleviating post-stroke neurological disorders were 0.30-fold lower (95% CI = 0.21-0.43) in the DTD group than the control (Western medicine) group (P < 0.000 01). Moreover, regardless of the type of stroke diagnostic scale applied (including NFA, HDS, and NIHSS), the overall post-stroke symptoms determined were less severe in the DTD group (n = 219) than the control group (n = 217). No adverse effects of DTD were observed in the 11 RCTs reviewed. All 11 studies used an appropriate method for randomization of subjects to evaluate the risk of bias (ROB), and 7 studies included allocation concealment as well as blinding of patients and practitioners. High-risk ROB was included in 6 RCTs. No significant publication bias was derived from the funnel plot. Our results indicate that the administration of DTD alone, and DTD in combination with Western medicine, exert greater efficacy for post-stroke complication therapy, than Western medicine administered alone. More rigorous and regulated studies are required to confirm the therapeutic efficacy of DTD for post-stroke neurological disorders. disorders.
中风后并发症的管理对生活质量起着重要作用。涤痰汤（DTD）是一种广泛应用的中药。本研究通过系统评价和荟萃分析来评估涤痰汤治疗中风后神经功能障碍的疗效。从英文、中文和韩文电子医学数据库中搜索随机对照试验（RCT），关键词包括“涤痰汤”、“涤痰汤”、“化痰汤”、“中风”和“RCT”。每个 RCT 均包括对照组（安慰剂、常规治疗或西药）和实验组（涤痰汤治疗）。对于中风后 1-6 周的患者，中风后症状量表测量中风后神经功能障碍的结果，并分为“完全治愈”、“显效”、“有效”和“无效”。从最初搜索中确定的 210 篇文章中总共选择了 11 项 RCT（n=490 例对照组和 n=502 例涤痰汤组）。中风后症状评价标准的荟萃分析显示，与对照组（西药组）相比，涤痰汤组缓解中风后神经功能障碍的总优势比（ORs）降低了 0.30 倍（95%CI=0.21-0.43）（P<0.00001）。此外，无论应用哪种类型的中风诊断量表（包括 NFA、HDS 和 NIHSS），涤痰汤组（n=219）的总体中风后症状都比对照组（n=217）更轻。在评价的 11 项 RCT 中，均未观察到涤痰汤的不良反应。所有 11 项研究均采用了适当的方法对受试者进行随机分组，以评估偏倚风险（ROB），其中 7 项研究还包括了对患者和实施者的分配隐藏和盲法。在 6 项 RCT 中存在高风险的 ROB。漏斗图未得出明显的发表偏倚。我们的结果表明，单独使用涤痰汤和涤痰汤联合西药治疗中风后并发症的疗效优于单独使用西药。需要更严格和规范的研究来证实涤痰汤治疗中风后神经功能障碍的疗效。
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