Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong, P. R. China.
Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong, P. R. China.
Am J Chin Med. 2023;51(3):517-546. doi: 10.1142/S0192415X2350026X. Epub 2023 Feb 28.
The objective of this study was to evaluate the efficacy and safety of Chinese patent medicine compared with western medicine in the treatment of Alzheimer's disease using the Network Meta-analysis. This study retrieved relevant studies from 7 databases, and the retrieval time was from the establishment of each database to June 2022. After the screening, data extraction, and quality assessment, 47 studies were finally analyzed, involving 11 Chinese patent medicines. The results demonstrated that Chinese patent medicine intervention was superior to oral western medicine treatment in improving the patient's condition as assessed by the Mini-mental State Examination (MMSE), Activities of Daily Living (ADL), effective rate, and Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-Cog). Particularly, the effect of Chinese patent medicine combined with western medicine intervention was prominent. Meanwhile, Chinese patent medicine intervention in AD did not significantly increase the risk of adverse reactions. The results of the Network Meta-analysis demonstrated that Chinese patent medicine combined with western medicine had statistically significant differences in the MMSE score, ADL score, effective rate, and ADAS-Cog score, compared with both western medicine alone and Chinese patent medicine alone. In terms of adverse reactions, the difference between Chinese patent medicine intervention and simple oral western medicine was statistically significant. The results of further ranking probability analysis demonstrated that Chinese patent medicine combined with western medicine intervention ranked first in terms of MMSE, ADL, effective rate, and ADAS-Cog. Additionally, oral Chinese patent medicine intervention alone ranked first in reducing adverse reactions. In the funnel plots of the MMSE, ADL, and effective rate, most studies were symmetrically distributed on both sides of the midline, where small sample effects and publication bias might exist to some extent. However, this conclusion still needs to be combined with clinical syndrome differentiation and treatment, and more large-sample, multi-center, high-quality studies are needed for further verification.
本研究旨在采用网状 Meta 分析评价中药治疗阿尔茨海默病的疗效和安全性。本研究从 7 个数据库中检索相关研究，检索时间为各数据库建立至 2022 年 6 月。经过筛选、数据提取和质量评估，最终分析了 47 项研究，涉及 11 种中药。结果表明，中药干预在改善患者的病情方面优于口服西药治疗，表现在简易精神状态检查（MMSE）、日常生活活动能力（ADL）、有效率和阿尔茨海默病评估量表-认知部分（ADAS-Cog）。特别是中药联合西药干预的效果更为显著。同时，中药干预阿尔茨海默病并未显著增加不良反应的风险。网状 Meta 分析结果表明，中药联合西药在 MMSE 评分、ADL 评分、有效率和 ADAS-Cog 评分方面与单独使用西药和单独使用中药相比，均具有统计学差异。在不良反应方面，中药干预与单纯口服西药之间的差异具有统计学意义。进一步的排序概率分析结果表明，中药联合西药干预在 MMSE、ADL、有效率和 ADAS-Cog 方面排名第一。此外，口服中药单独干预在降低不良反应方面排名第一。在 MMSE、ADL 和有效率的漏斗图中，大多数研究的点均对称分布在中线两侧，可能存在小样本效应和发表偏倚，但这一结论仍需结合临床辨证施治，需要更多大样本、多中心、高质量的研究进一步验证。
