Zhu Li-Jian, DU Hao-Ran, Li Hai-Long, Wang Yu, Yang Zhen
School of Life Sciences, Zhejiang Chinese Medical University Hangzhou 310053, China.
the First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou 310009, China.
Zhongguo Zhong Yao Za Zhi. 2023 Jun;48(11):3097-3109. doi: 10.19540/j.cnki.cjcmm.20230131.501.
This study aimed to compare the efficacy of Qi-benefiting and blood-activating Chinese patent medicines in the treatment of ischemic stroke with network Meta-analysis. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library were searched from database inception to October 2022 for randomized controlled trial(RCT) on 11 Qi-benefiting and blood-activating Chinese patent medicines in the treatment of ischemic stroke. The risk of bias plot was made by RevMan 5.3, and network Meta-analysis and efficacy ranking were performed by Stata 17. Ninety-two RCTs were included, involving 10 608 patients. According to the network Meta-analysis, in terms of the clinical total effective rate, surface under the cumulative ranking curve(SUCRA) as followed: Qilong Capsules+conventional western medicine>Zhishe Tongluo Capsules+conventional western medicine>Longshengzhi Capsules+conventional western medicine>Naoxintong Capsules+conventional western medicine>Tongsaimai Tablets+conventional western medicine>Naoan Capsules+conventional western medicine>Naoluotong Capsules+conventional western medicine>Xiaoshuan Changrong Capsules+conventional western medicine>Dengzhan Shengmai Capsules+conventional western medicine=Tongxinluo Capsules+conventional western medicine>Naomaitai Capsules+conventional western medicine. In terms of the improvement in National Institute of Health stroke scale(NIHSS) score, SUCRA as followed: Longshengzhi Capsules+conventional western medicine>Naomaitai Capsules+conventional western medicine>Naoxintong Capsules+conventional western medicine>Dengzhan Shengmai Capsules+conventional western medicine>Xiaoshuan Changrong Capsules+conventional western medicine>Naoluotong Capsules+conventional western medi-cine>Tongxinluo Capsules+conventional western medicine>Naoan Capsules+conventional western medicine>Qilong Capsules+conventional western medicine. In terms of safety, the overall adverse reactions/events of Qi-benefiting and blood-activating Chinese patent medicines + conventional western medicine were less than those of the control group. Since Qilong Capsules+conventional western medicine and Zhishe Tongluo Capsules+conventional western medicine were preferred to improve the clinical total effective rate. In the aspect of improving NIHSS score, Longshengzhi Capsules+conventional western medicine and Naomaitai Capsules+conventional western medicine were first options. Due to the lack of direct comparisons between drugs, the overall quality of RCT was not high, so more studies are needed to verify the strength of the evidence.
本研究旨在通过网状Meta分析比较益气活血类中成药治疗缺血性脑卒中的疗效。检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase和Cochrane图书馆，检索时间从建库至2022年10月，查找关于11种益气活血类中成药治疗缺血性脑卒中的随机对照试验（RCT）。采用RevMan 5.3绘制偏倚风险图，并用Stata 17进行网状Meta分析和疗效排序。共纳入92项RCT，涉及10608例患者。根据网状Meta分析，在临床总有效率方面，累积排序曲线下面积（SUCRA）结果如下：芪龙胶囊+常规西药＞蛭蛇通络胶囊+常规西药＞龙生蛭胶囊+常规西药＞脑心通胶囊+常规西药＞通塞脉片+常规西药＞脑安胶囊+常规西药＞脑络通胶囊+常规西药＞消栓肠溶胶囊+常规西药＞灯盏生脉胶囊+常规西药=通心络胶囊+常规西药＞脑脉泰胶囊+常规西药。在改善美国国立卫生研究院卒中量表（NIHSS）评分方面，SUCRA结果如下：龙生蛭胶囊+常规西药＞脑脉泰胶囊+常规西药＞脑心通胶囊+常规西药＞灯盏生脉胶囊+常规西药＞消栓肠溶胶囊+常规西药＞脑络通胶囊+常规西药＞通心络胶囊+常规西药＞脑安胶囊+常规西药＞芪龙胶囊+常规西药。在安全性方面，益气活血类中成药+常规西药的总体不良反应/事件少于对照组。由于芪龙胶囊+常规西药和蛭蛇通络胶囊+常规西药在提高临床总有效率方面更具优势。在改善NIHSS评分方面，龙生蛭胶囊+常规西药和脑脉泰胶囊+常规西药为首选。由于药物之间缺乏直接比较，RCT的总体质量不高，因此需要更多研究来验证证据的强度。
