中国中医急症
中國中醫急癥
중국중의급증
JOURNAL OF EMERGENCY IN TRADITIONAL CHINESE MEDICINE
2015年
4期
569-572,617
,共5页
聂莉媛%张青%王潇慧%孙金%张媛%刘金民
聶莉媛%張青%王瀟慧%孫金%張媛%劉金民
섭리원%장청%왕소혜%손금%장원%류금민
成人癫痫%中医药%系统评价%Meta分析
成人癲癇%中醫藥%繫統評價%Meta分析
성인전간%중의약%계통평개%Meta분석
Adult Epilepsy%Chinese herbal medicine%Systematic review%Meta Analysis
目的：系统评价中医药治疗成人癫痫的临床疗效及安全性。方法采用计算机检索和手工检索文献，纳入以成人癫痫患者为研究对象、中医药治疗的随机/半随机对照试验。采用改良的Jadad量表进行质量评价，运用RevMan 5.2进行统计学分析。结果最终纳入73项试验，其中72项涉及总有效率，仅有5项涉及症状积分，30项涉及脑电图改善，36项涉及不良反应及副作用。文献质量普遍较低。系统评价结果显示，在减少患者痫性发作频率、提高总有效率方面，辨证论治/经方加减/中成药联合西药组总有效率明显高于西药组（OR=3.47，95%CI为2.70~4.47，P<0.00001），自拟方加减联合西药组总有效率明显高于西药组（RR=1.22，95%CI为1.17~1.28，P<0.00001），中药联合针刺（耳穴压豆）、西药组疗效明显优于西药组（OR=5.26，95%CI为1.97~14.01，P=0.0009）；在症状积分改善方面，中药组及辨证论治/经方加减/中成药联合西药组疗效均明显优于西药组；在脑电图改善方面，中药组疗效明显优于西药组（RR=1.33，95%CI为1.14~1.56，P=0003），辨证论治/经方加减/中成药联合西药组疗效明显优于西药组（OR=2.11，95%CI为1.30~3.42，P=0.002）；自拟方加减联合西药组疗效明显优于西药组（OR=2.93，95%CI为1.91~4.49，P<0.00001）。结论中医药治疗成人癫痫在提高总有效率、改善症状积分及脑电图等方面，具有明显优势；中医药治疗成人癫痫未发现严重不良反应。在常规西药治疗基础上加用中医药治疗成人癫痫，可以提高临床疗效。但仍需高质量文献提供循证医学的最佳证据。
目的：繫統評價中醫藥治療成人癲癇的臨床療效及安全性。方法採用計算機檢索和手工檢索文獻，納入以成人癲癇患者為研究對象、中醫藥治療的隨機/半隨機對照試驗。採用改良的Jadad量錶進行質量評價，運用RevMan 5.2進行統計學分析。結果最終納入73項試驗，其中72項涉及總有效率，僅有5項涉及癥狀積分，30項涉及腦電圖改善，36項涉及不良反應及副作用。文獻質量普遍較低。繫統評價結果顯示，在減少患者癇性髮作頻率、提高總有效率方麵，辨證論治/經方加減/中成藥聯閤西藥組總有效率明顯高于西藥組（OR=3.47，95%CI為2.70~4.47，P<0.00001），自擬方加減聯閤西藥組總有效率明顯高于西藥組（RR=1.22，95%CI為1.17~1.28，P<0.00001），中藥聯閤針刺（耳穴壓豆）、西藥組療效明顯優于西藥組（OR=5.26，95%CI為1.97~14.01，P=0.0009）；在癥狀積分改善方麵，中藥組及辨證論治/經方加減/中成藥聯閤西藥組療效均明顯優于西藥組；在腦電圖改善方麵，中藥組療效明顯優于西藥組（RR=1.33，95%CI為1.14~1.56，P=0003），辨證論治/經方加減/中成藥聯閤西藥組療效明顯優于西藥組（OR=2.11，95%CI為1.30~3.42，P=0.002）；自擬方加減聯閤西藥組療效明顯優于西藥組（OR=2.93，95%CI為1.91~4.49，P<0.00001）。結論中醫藥治療成人癲癇在提高總有效率、改善癥狀積分及腦電圖等方麵，具有明顯優勢；中醫藥治療成人癲癇未髮現嚴重不良反應。在常規西藥治療基礎上加用中醫藥治療成人癲癇，可以提高臨床療效。但仍需高質量文獻提供循證醫學的最佳證據。
목적：계통평개중의약치료성인전간적림상료효급안전성。방법채용계산궤검색화수공검색문헌，납입이성인전간환자위연구대상、중의약치료적수궤/반수궤대조시험。채용개량적Jadad량표진행질량평개，운용RevMan 5.2진행통계학분석。결과최종납입73항시험，기중72항섭급총유효솔，부유5항섭급증상적분，30항섭급뇌전도개선，36항섭급불량반응급부작용。문헌질량보편교저。계통평개결과현시，재감소환자간성발작빈솔、제고총유효솔방면，변증론치/경방가감/중성약연합서약조총유효솔명현고우서약조（OR=3.47，95%CI위2.70~4.47，P<0.00001），자의방가감연합서약조총유효솔명현고우서약조（RR=1.22，95%CI위1.17~1.28，P<0.00001），중약연합침자（이혈압두）、서약조료효명현우우서약조（OR=5.26，95%CI위1.97~14.01，P=0.0009）；재증상적분개선방면，중약조급변증론치/경방가감/중성약연합서약조료효균명현우우서약조；재뇌전도개선방면，중약조료효명현우우서약조（RR=1.33，95%CI위1.14~1.56，P=0003），변증론치/경방가감/중성약연합서약조료효명현우우서약조（OR=2.11，95%CI위1.30~3.42，P=0.002）；자의방가감연합서약조료효명현우우서약조（OR=2.93，95%CI위1.91~4.49，P<0.00001）。결론중의약치료성인전간재제고총유효솔、개선증상적분급뇌전도등방면，구유명현우세；중의약치료성인전간미발현엄중불량반응。재상규서약치료기출상가용중의약치료성인전간，가이제고림상료효。단잉수고질량문헌제공순증의학적최가증거。
Objective:To assess the efficacy and safety of treatment Adult Epilepsy with Chinese herbal medi?cine. Methods:RCTs of treating Adult Epilepsy with Chinese herbal medicine were collected comprehensively by computer and manual searches. The trials were assessedby the Jadad scale integral method,and RevMan 5.2 was used for statistical analysis. Results:Seventy-three trials were included,seventy-two trials relating to the to?tal effective rate,only five trials relating to symptom score,thrity trials relating to Electroencephalogram(EEG), thrity-six trials relating to adverse reaction. The methodological quality was generally low. Result of mete-analy?sis showed that the treatment by differentiation of syndromes(Bianzheng-Lunzhi)/classical prescription/proprie?tary Chinese medicine combined with anti-epilepsy drugs(AEDs)groups could significantly improve the total ef?fective rate compared with the Western medicine group(OR 3.47,95%CI 2.70-4.47,P<0.00001),self-made de?coction combined with AEDs group could significantly improve the total effective rate compared with the West?ern medicine group(RR 1.22,95%CI 1.17-1.28,P<0.00001),Chinese herbal medicine combined with acupunc?ture and AEDs group was superior to Western medicine group in improving the clinical efficacy(OR 5.26,95%CI 1.97-14.01,P=0.0009);the Chinese herbal medicine/ the treatment by differentiation of syndromes(Bian?zheng-Lunzhi)/classical prescription/proprietary Chinese medicine combined with AEDs groups could significant?ly improve symptom score compared with the Western medicine group;the Chinese herbal medicine group could significantly improve the EEG compared with the Western medicine group(RR 1.33,95%CI 1.14-1.56,P=0.0003),the treatment by differentiation of syndromes(Bianzheng-Lunzhi)/classical prescription/proprietary Chi?nese medicine combined with AEDs groups could significantly improve the EEG compared with the Western medicine group(OR 2.11,95%CI 1.30-3.42,P=0.002),self-made decoction combined with AEDs group could significantly improve the EEG compared with the Western medicine group(OR 2.93,95%CI 1.91-4.49,P<0.00001). Conclusion:Compared with the Western medicine,Chinese herbal medicine has obvious efficacy in improving the total effective rate,symptom score,and EEG,and did not discovery seriously adverse reaction. On the basis of AEDs combined with Chinese herbal medicine can improve the clinical efficacy in treating adult epi?lepsy,but more high methodological quality trials are needed for further confirmation.
