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1.中国中医科学院 针灸研究所,北京 100700
2.中国中医科学院 中医临床基础医学研究所 循证医学基础研究室,北京 100700
3.北京中医药大学 东直门医院,北京 100700
4.北京中医药大学 中医脑病研究院,北京 101121
5.北京中医药大学 第三附属医院,北京 100091
Received:28 December 2021,
Published Online:02 June 2022,
Published:20 October 2022
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田紫煜,孔令博,张重阳等.口服中成药治疗缺血性脑卒中临床研究证据的概况性综述[J].中国实验方剂学杂志,2022,28(20):154-160.
TIAN Ziyu,KONG Lingbo,ZHANG Chongyang,et al.Clinical Evidence of Oral Chinese Patent Medicine for Ischemic Stroke: A Scoping Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2022,28(20):154-160.
田紫煜,孔令博,张重阳等.口服中成药治疗缺血性脑卒中临床研究证据的概况性综述[J].中国实验方剂学杂志,2022,28(20):154-160. DOI: 10.13422/j.cnki.syfjx.20222091.
TIAN Ziyu,KONG Lingbo,ZHANG Chongyang,et al.Clinical Evidence of Oral Chinese Patent Medicine for Ischemic Stroke: A Scoping Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2022,28(20):154-160. DOI: 10.13422/j.cnki.syfjx.20222091.
该文基于概况性综述方法,系统检索与梳理口服中成药治疗缺血性脑卒中的临床研究,了解相关主题的证据分布概况。通过手工检索三大药物目录,获得可用于缺血性脑卒中的口服中成药,并检索7大常用文献数据库,纳入此类中成药的临床研究,通过可视化方法分析相关临床证据概况。共手工检索到68种口服中成药,纳入1 392篇文献,其中核心期刊367篇,涉及35种口服中成药,研究类型包括随机对照试验(RCT)、队列研究、病例系列、个案报告、二次研究、药物不良反应报告、药物经济学评价、药物交互作用、共识或指南、非随机干预研究、横断面研究等,其中RCT数量最多283项(77.1%),其次是二次研究和病例系列研究,各25项(各占6.7%)。在283项RCT中,急性期的临床研究159项,非急性期65项,不明分期59项;共归纳10种干预措施对照类型;20种结局指标类型,其中复合型结局指标及替代结局指标分别使用217次(76.7%)、245次(86.6%),其次是神经功能缺损程度(包含3种测量量表)。未来缺血性脑卒中口服中成药的临床研究需要明确疾病分期、针对中成药干预的优势环节进行设计,且干预措施对照类型应尽量选用公认的阳性对照,在结局指标选择方面应使用临床重要结局指标。
The method of scoping review was used to systematically search and sort out the clinical research of oral Chinese patent medicines for ischemic stroke,to understand the scope of relevant research and the distribution of evidence. Three medical catalogs were manually searched to obtain the oral Chinese patent medicines used for ischemic stroke,and 7 databases were retrieved to obtain the clinical research including these oral Chinese patent medicines. Then the clinical evidence results were visualized by description combined with chart analysis. A total of 68 oral Chinese patent medicines were retrieved,and 1 392 articles were included,with 367 published in core journals, involving 35 oral Chinese patent medicines. The research types included randomized controlled trials,cohort studies,case series,case reports,secondary studies,adverse drug reaction reports,pharmacoeconomic evaluations,drug interactions,consensus or guidelines,non-randomized intervention studies and cross-sectional studies,of which randomized controlled trials had the largest number (283, 77.1%),followed by secondary studies and case series (25, 6.7% for each). Among the 283 randomized controlled trials,there were 159 clinical studies in the acute phase of ischemic stroke,65 in the non-acute phase,and 59 in the unclear phase. Ten intervention control types and 20 outcome index types were summarized. Among them, the composite outcome index and surrogate outcome index were used 217 times (76.7%) and 245 times (86.6%), respectively,followed by the degree of neurological impairment (three scales). Future clinical research of oral Chinese patent medicines for ischemic stroke should clarify the stage of the disease,and the research design should specify the advantages of oral Chinese patent medicines intervening in ischemic stroke. Furthermore, publicly-recognized positive controls should be employed,and important clinical outcome indexes should be selected.
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