Jo Hee-Geun, Lee Donghun
Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju 61949, Korea.
Department of Bioinformatics and Statistics, Graduate School of Korea National Open University, 86 Daehak-ro, Jongro-gu, Seoul 03087, Korea.
Pharmaceuticals (Basel). 2021 Nov 22;14(11):1202. doi: 10.3390/ph14111202.
This review aimed to comprehensively assess the efficacy and safety of oral East Asian herbal medicine (EAHM) for overall peripheral neuropathy (PN). In addition, an Apriori algorithm-based association rule analysis was performed to identify the core herb combination, thereby further generating useful hypotheses for subsequent drug discovery. A total of 10 databases were searched electronically from inception to July 2021. Randomized clinical trials (RCTs) comparing EAHM with conventional analgesic medication or usual care for managing PN were included. The RCT quality was appraised using RoB 2.0, and the random effects model was used to calculate the effect sizes of the included RCTs. The overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation. By analyzing the constituent herb data, the potential association rules of core herb combinations were explored. A total of 67 RCTs involving 5753 patients were included in this systematic review. In a meta-analysis, EAHM monotherapy and combined EAHM and western medicine therapy demonstrated substantially improved sensory nerve conduction velocity, motor nerve conduction velocity, and response rate. Moreover, EAHM significantly improved the incidence rate, pain intensity, Toronto clinical scoring system, and Michigan diabetic neuropathy score. The evidence grade was moderate to low due to the substantial heterogeneity among the studies. Nine association rules were identified by performing the association rule analysis on the extraction data of 156 EAHM herbs. Therefore, the constituents of the herb combinations with consistent association rules were Astragali Radix, Cinnamomi Ramulus, and Spatholobi Calulis. This meta-analysis supports the hypothesis that EAHM monotherapy and combined therapy may be beneficial for PN patients, and follow-up research should be conducted to confirm the precise action target of the core herb.
本综述旨在全面评估口服东亚草药（EAHM）治疗全身性周围神经病变（PN）的疗效和安全性。此外，还进行了基于Apriori算法的关联规则分析，以确定核心草药组合，从而为后续药物研发进一步提出有用的假设。从数据库建立至2021年7月，通过电子检索了总共10个数据库。纳入了比较EAHM与传统止痛药物或常规护理用于治疗PN的随机临床试验（RCT）。使用RoB 2.0评估RCT的质量，并采用随机效应模型计算纳入RCT的效应量。根据推荐分级评估、制定和评价（GRADE）对证据的总体质量进行评估。通过分析草药成分数据，探索核心草药组合的潜在关联规则。本系统评价共纳入67项RCT，涉及5753例患者。在一项荟萃分析中，EAHM单药治疗以及EAHM与西药联合治疗均显示感觉神经传导速度、运动神经传导速度和缓解率有显著改善。此外，EAHM显著改善了发病率、疼痛强度、多伦多临床评分系统和密歇根糖尿病神经病变评分。由于各研究之间存在较大异质性，证据等级为中到低。通过对156种EAHM草药的提取数据进行关联规则分析，确定了九条关联规则。因此，具有一致关联规则的草药组合成分是黄芪、桂枝和鸡血藤。这项荟萃分析支持了EAHM单药治疗和联合治疗可能对PN患者有益的假设，后续研究应进一步证实核心草药的确切作用靶点。
