刘红杰;何涛志;张炅璐;吴倩;谭莉娟;刘东东;
LIU Hong-jie;HE Tao-zhi;ZHANG Jiong-lu;WU Qian;TAN Li-juan;LIU Dong-dong;College of Traditional Chinese Medicine, Ji′nan University;

• 1:暨南大学中医学院

摘要(Abstract)：

系统评价中药复方联合左旋多巴类药物治疗帕金森病(Parkinson′s disease,PD)的疗效,筛选基础用药,为更好地指导临床用药提供一定的循证医学依据及方案。检索国内外6个数据库,筛选中药复方联合左旋多巴类药物治疗PD的随机对照试验(RCT);运用改良后的Jadad评分量表和RevMan 5.3软件对最终纳入文献进行质量评价和Meta分析,并将其中涉及的中药复方进行数据整理,运用IBM SPSS Modeler 18.0软件的Apriori算法寻找强关联规则,进而寻求治疗PD中药的基础用药。最终纳入20项研究,共1 784例患者,Jadad评分10篇为高质量文献,评分≥4分。Meta分析结果表明,在常规基础治疗上,加用中药复方治疗PD的试验组在统一帕金森病评分量表(UPDRS)Ⅰ(MD=-0.43,95%CI[-0.62,-0.24],P<0.000 1),UPDRSⅡ(MD=-2.72,95%CI[-3.24,-2.21],P<0.000 01),UPDRSⅢ[MD=-1.97,95%CI[-2.69,-1.25],P<0.000 01),UPDRSⅣ(MD=-0.28,95%CI[-0.46,-0.11],P=0.002)以及根据UPDRS减分率计算的有效率(OR=4.81,95%CI[3.50,6.62],P<0.000 01)改善方面,优于单独使用常规基础治疗,差异均具有统计学意义。数据挖掘结果表明,总体上治疗PD基础方:白芍-熟地黄-天麻;治疗UPDRSⅠ方面,白芍-熟地黄-炙甘草,其中炙甘草可能对这一方面有独特疗效;治疗UPDRSⅡ,UPDRSⅢ方面,白芍-熟地黄或者川芎-当归2组药物组合;治疗UPDRSⅣ方面则用药较分散。但鉴于纳入临床研究在数量及质量上存在一定局限性,得出的结果仍需临床进一步证实其疗效。
To systematically evaluate the efficacy of traditional Chinese medicine(TCM) compounds combined with levodopa medicine in the treatment of Parkinson′s disease(PD), and screen basic herbs to provide certain evidence-based medical proof and program for better guidance on clinical drug use. Six databases were searched to screen out the randomized controlled trial on the TCM compounds combined with levodopa medicine in the treatment of PD. Literature quality of the included studies was evaluated by improved Jadad rating scale, and the Meta-analysis was performed by RevMan 5.3 software. After the data of the basic TCM compounds involved were sorted out, the strong association rules were found by using Apriori algorithm of SPSS Modeler 18.0 software, and then the basic herbs for the treatment of PD could be picked out. A total of 20 studies were eventually included, involving 1 784 patients. Ten studies were of high-quality literature, Jadad score≥4 points. Meta-analysis showed that efficacy of TCM combined with levodopa medicine was better than levodopa medicine alone in lowering Unified Parkinson′s Disease Rating Scale(UPDRS) score: UPDRS Ⅰ(MD=-0.43, 95%CI[-0.62,-0.24], P<0.000 1), UPDRS Ⅱ(MD=-2.72, 95%CI[-3.24,-2.21], P<0.000 01), UPDRS Ⅲ(MD =-1.97, 95%CI[-2.69,-1.25], P<0.000 01), UPDRS Ⅳ(MD=-0.28, 95%CI[-0.46,-0.11], P=0.002). And the improvement in UPDRS score reduction rate of TCM combined with levodopa medicine was better than that in levodopa medicine alone: effective rate(OR=4.81, 95%CI[3.50, 6.62], P<0.000 01). Data mining results showed that the basic prescription for treating PD consisted of Paeoniae Radix Alba-Rehmanniae Radix Praeparata-Gastrodiae Rhizoma in general. According to each part of UPDRS, the basic prescription for treating mentation, behavior and mood(UPDRS Ⅰ) consists of Paeoniae Radix Alba-Rehmanniae Radix Praeparata-Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle, Among which Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle might have unique efficacy. The basic prescriptions for treating UPDRS Ⅱ and UPDRS Ⅲ consisted of Paeoniae Radix Alba-Rehmanniae Radix Praeparata, or Chuanxiong Rhizoma-Angelicae Sinensis Radix(two drug combinations). However, in the treatment of UPDRS Ⅳ, the drugs were scattered. But due to the limitations in the quantity and quality of clinical studies, the results obtained still need further research and clinical confirmation of its efficacy.

关键词(KeyWords)： 中药复方;左旋多巴类药物;帕金森病;系统评价;数据挖掘
traditional Chinese medicine compound;levodopa medicine;Parkinson′s disease;systematic review;data mining

Abstract:

Keywords:

基金项目(Foundation): 广东省基础与应用基础研究基金项目(2019A1515010644)

作者(Author): 刘红杰;何涛志;张炅璐;吴倩;谭莉娟;刘东东;
LIU Hong-jie;HE Tao-zhi;ZHANG Jiong-lu;WU Qian;TAN Li-juan;LIU Dong-dong;College of Traditional Chinese Medicine, Ji′nan University;

Email:

DOI: 10.19540/j.cnki.cjcmm.20200717.501

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