康复学报 (Dec 2021)
System Evaluation of Buyang Huanwu Decoction in Treatment of Acute Ischemic Stroke
Abstract
ObjectiveMeta analysis was used to evaluate the efficacy and safety of Buyang Huanwu decoction in the treatment of patients with acute ischemic stroke, so as to provide evidence-based basis for the clinical application of Buyang Huanwu decoction.MethodsData were searched from the databases of PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, VIP and CBMdisc. Patients with acute ischemic stroke with Qi deficiency and blood stasis syndrome differentiation in traditional Chinese medicine were included in the randomized controlled trials (RCTs), who were treated with Buyang Huanwu decoction. The retrieval time for each database was from January 1, 2015 to January 31, 2020. The main outcome indicators were clinical total effective rate, Fugl-Meyer assement (FMA); and the secondary outcome indicators were D-dimer content, plasma fibrinogen content, homocysteine (Hcy) content and adverse reaction. Two researchers independently screened literature, extracted data and evaluated the quality of literature. Revman 5.3 software was used to analyze the data. According to the system review manual provided by the Cochrane Collaboration Network, mean difference (MD) and 95% confidence interval (CI) were used as indicators for continuous variables, and risk ratio (RR) and 95% CI were used as indicators for enumeration data. The statistical heterogeneity was judged comprehensively by the Heterogeneity value (I2 value) and probability value (P value). If P>0.1 and I2<50%, a fixed effect model would be used. In contrast, if P≤0.1 or I2≥50%, a random effect model would be used.ResultsA total of 22 RCTs (2 078 cases) were included, with 1 040, 1 038 cases in the control group and the experimental group respectively. The results of meta-analysis showed that, compared with the control group, the total clinical effective rate of the experimental group was higher［RR=1.21, 95% CI (1.17, 1.26), Z=9.73, P<0.000 01］, the FMA score was higher [MD=6.88，95% CI (5.48, 8.27), Z=9.67, P<0.000 01], the content of D-dimer was lower [MD=-0.42, 95% CI (-0.53, -0.32), Z=7.96, P<0.000 01], and the content of plasma fibrinogen was lower [MD=-0.50, 95% CI (-0.61, -0.40), Z=9.40, P<0.000 01], Hcy level was lower [MD=-2.78, 95% CI (-3.60, -1.96), Z=6.64, P<0.000 01]. There was no significant difference in treatment safety between the two groups [RR=1.00, 95% CI (0.45, 2.24), Z=0.00, P=1.00].ConclusionBuyang Huanwu decoction can effectively improve the clinical efficacy of acute ischemic stroke, improve the degree of neurological deficit and limb motor function, and the treatment safety is good. In the future study, large samples and high-quality clinical randomized controlled trials will be in need to provide more reliable evidence-based basis for clinical practice.
