CAJ | 학술논문

目的：系统评价星蒌承气汤加减治疗脑卒中急性期的疗效性与安全性。方法应用计算机、手工结合方式在全面检索中国学术期刊全文数据库、万方知识服务平台等数据库中进行文献检索，搜集1991年-2014年相关文献，纳入合格的随机对照文献后，按照CoChrane协作网标准，应用Jadad评分法给予质量评价，应用RevMan5．1软件进行Meta分析。结果经筛选纳入19篇文献，共1467例，治疗组755例，对照组712例，各研究基线可比。应用Jadad量表评价文章质量，1篇试验得5分属高质量文献，5篇试验得3分属中等质量文献，其余均低于3分属低质量文献。Meta分析结果显示：星蒌承气汤加减联合西药常规治疗在提高脑卒中病急性期总的临床疗效[RR＝1．29，95％CI（1．22，1．37）]、降低神经功能缺损评分[WMD＝-4．29，95％CI（-6．13，-2．45）]、降低大便症状积分[WMD＝-3．63，95％CI（-4．33，-2．93）]、降低中医证候积分[WMD＝-3．01，95％CI（-4．31，-1．7）]、提高日常生活活动能力[WMD＝9．07，95％CI（5．46，12．67）]、降低高切血黏度[WMD＝-0．93，95％CI（-1．4，-0．46）]、低切血黏度[WMD＝-1．68，95％CI（-2．95，-0．4）]、纤维蛋白[WMD＝-0．5，95％CI（-0．96，-0．04）]方面均优于治疗组。在降低脑卒中病死率[OR＝0．59，95％CI（0．26，1．34），P＝0．21]及血CRP[WMD＝-0．66，95％CI（-2．08，0．76），P＝0．36]方面无统计学意义。结论目前拥有的数据表明，星蒌承气汤加减联合西药常规治疗脑卒中急性期的疗效是优于对照组的，但尚不认为其具有降低急性脑卒中病死率的作用。受纳入文献质量和数量的限制，仍然需要纳入更多高质量、多中心、大样本量，且应该经过严格设计的随机双盲对照试验支持临床疗效。
목적：계통평개성루승기탕가감치료뇌졸중급성기적료효성여안전성。방법응용계산궤、수공결합방식재전면검색중국학술기간전문수거고、만방지식복무평태등수거고중진행문헌검색，수집1991년-2014년상관문헌，납입합격적수궤대조문헌후，안조CoChrane협작망표준，응용Jadad평분법급여질량평개，응용RevMan5．1연건진행Meta분석。결과경사선납입19편문헌，공1467례，치료조755례，대조조712례，각연구기선가비。응용Jadad량표평개문장질량，1편시험득5분속고질량문헌，5편시험득3분속중등질량문헌，기여균저우3분속저질량문헌。Meta분석결과현시：성루승기탕가감연합서약상규치료재제고뇌졸중병급성기총적림상료효[RR＝1．29，95％CI（1．22，1．37）]、강저신경공능결손평분[WMD＝-4．29，95％CI（-6．13，-2．45）]、강저대편증상적분[WMD＝-3．63，95％CI（-4．33，-2．93）]、강저중의증후적분[WMD＝-3．01，95％CI（-4．31，-1．7）]、제고일상생활활동능력[WMD＝9．07，95％CI（5．46，12．67）]、강저고절혈점도[WMD＝-0．93，95％CI（-1．4，-0．46）]、저절혈점도[WMD＝-1．68，95％CI（-2．95，-0．4）]、섬유단백[WMD＝-0．5，95％CI（-0．96，-0．04）]방면균우우치료조。재강저뇌졸중병사솔[OR＝0．59，95％CI（0．26，1．34），P＝0．21]급혈CRP[WMD＝-0．66，95％CI（-2．08，0．76），P＝0．36]방면무통계학의의。결론목전옹유적수거표명，성루승기탕가감연합서약상규치료뇌졸중급성기적료효시우우대조조적，단상불인위기구유강저급성뇌졸중병사솔적작용。수납입문헌질량화수량적한제，잉연수요납입경다고질량、다중심、대양본량，차응해경과엄격설계적수궤쌍맹대조시험지지림상료효。
O bjective The objective w as to system a tica ly assess cura tive effect and security of X ing lou Chengqi decoction (XCD) fo r trea tm ent of acute stroke. Methods The da tabases including C hina Journa lFul TextD a tabase (C JFD) and W anFang Da tabase from 1991 to 2014 w ere re trieved fo r co lecting the random ized contro led tria ls litera ture tha tmet inclusion criteria. The qua lity of co lected litera ture w as eva lua ted acco rding to the RevM an 5.1 softw are ,and Jadad sco ring method recomm ended by Co-chrane Co labo ra tion w as used in meta ana lysis. Results There w ere 19 litera ture included 1 467 cases,there w ere 755 cases in trea tm ent group(treating w ith XCD and its additional and subtractive recipes com bining w estern medicine) and 712 in contro l group(treating only w ith w estern medicine). The base line da ta w as com parability. Based on Jadad sca le sco ring ,there w ere lo ts of low qua lity litera tures ge tting under 3 sco res ,except 1 high qua lity litera ture ge tting 5 sco res and 5 m iddle qua lity litera tures ge tting 3 sco res. This M e ta ana lysis result show ed tha t trea tm ent groupw as be tter than the contro l groupin im proving to ta l clinica l cura tive effect[ RR = 1.29,95% C I( 1.22,1.37)] ,decreasing N IHSS [WMD= - 4.29,95% C I( - 6.13,- 2.45)] ,reducing TCM syndromeinteg ra ls [WMD= - 3.01,95% C I( - 4.31,- 1.7)] ,reducing stoo l syndromeinteg ra ls [WMD= - 3.63,95% C I( - 4.33,- 2.93)] , i m proving activity of da ily living [WMD= 9.07,95% C I( 5.46,12.67)] ,reducing high plasm a viscosity [WMD= - 0.93,95% C I( -1.4,- 0.46)] ,reducing low plasm a viscosity [WMD= - 1.68,95% C I( - 2.95,- 0.40)] ,reducing fibrinogen [WMD= - 0.5,95% C I ( - 0.96,- 0.04)]. In the treatment group the case mortality [ OR = 0.59,95% C I(0.26,1.34) ,P = 0.21] and CRP[WMD= - 0.66,95% C I ( - 2.08,0.76) ,P = 0.36] had no sta tistica lm eaning. Conclusion The current evidence show ed trea tm ent grouphasd be tter effec-tiveness w hen com pared w ith contro l g roup,but there w as no t enough evidence to suppo rt it could reduce the case m o rta lity. Be-cause of the lim ita tion of litera ture quantity and qua lity,higher qua lity ,rigo rous design ,large sam ple ,m ultiple center and double blind random ized contro led tria ls w ere needed to suppo rt the clinica l effectiveness.