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Journal of Chinese Integrative Medicine ›› 2007, Vol. 5 ›› Issue (3): 247-254.doi: 10.3736/jcim20070304

• Original Clinical Research • Previous Articles     Next Articles

Treatment of Alzheimer disease: an evidence-based review

Rong-fang Ji1, Jian-zhao Niu1, Shu-qiang Xu2, Jian Li1, Ji-feng Wang1, Jian-ping Liu3   

  1. 1. Laboratory of Cell and Biochemistry, Beijing University of Chinese Medicine, Beijing 100029, China 2. China-Japan Friendship Hospital, Beijing 100029, China 3. Evidence-Based Chinese Medicine Center for Clinical Research and Evaluation, Beijing University of Chinese Medicine, Beijing 100029, China
    2. Laboratory of Cell and Biochemistry, Beijing University of Chinese Medicine, Beijing 100029, China
    3. Laboratory of Cell and Biochemistry, Beijing University of Chinese Medicine, Beijing 100029, China 2. China-Japan Friendship Hospital, Beijing 100029, China 3. Evidence-Based Chinese Medicine Center for Clinical Research and Evaluation, Beijing University of Chinese Medicine, Beijing 100029, China
  • Online:2007-05-31 Published:2007-05-15

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Objective: The purpose of this research was mainly two-fold: first, to get an understanding of current researches conducted on Alzheimer disease in China; second, to systematically evaluate and compare Alzheimer's treatment delivered by traditional Chinese medicine (TCM) and Western medicine.

Methods: Two steps were employed in this research. They were data collection and cleaning, followed by systemic review and qualitative analysis. The data were selected from the following two databases: CNKI (http://www.cnki.net)and Wanfang Data (http://www.wanfangdata.com.cn). Inclusion criteria were: (1) Chinese literature; (2) Published between year 1994 and year 2004; (3) Using TCM as treatment and Western medicine as control; (4) Similar research purposes and methodology; (5) Subjects were diagnosed as Alzheimer disease. Descriptive analysis , homogeneity test, meta analysis, sensitivity analysis and subgroup analysis were performed in the second step.

Result: Supposing all qualified studies were of high quality, we got the following conclusion: the advantage of TCM was losing because of the newly-developed acetylcholinesterase inhibitors came in market. Moreover, the studies conducted after year 2002 were more homogeneous in comparison with those conducted in early years. Those studies using mini-mental status examination (MMSE ) as outcome measurement were also more homogeneous than non-MMSE measurement groups. Combined odds ratio in comparative studies was 1.5 fold higher than that in experimental studies. Regarding to different outcome measurement, those studies using TCM assessment profile were 2.58(4.79/1.86) fold higher than those using MMSE as outcome measurement.

Conclusions: After systemic literature search, we found that only 40 out of 2 403 studies met our inclusion criteria. Moreover, those qualified studies were of low quality. Therefore, the external validity of this study would be compromised. The solution to this would be to improve study quality by strengthening study design and carefully select more homogeneous subjects in terms of syndrome differentiation, by so doing, the results of meta analysis will be more convincing and easily recognized by international society.

Key words: evidence-based medicine, Alzheimer disease, data analysis, statistical, therapy, TCM

CLC Number: 

  • R749.16

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研究编号 来源 年龄(岁) 性別 试验药物 对照药物 治疗天数 指标 参考文献
序号
1 穆2004 60~89 男12;女23 聪脑汤 石杉碱甲 56 HDS-R 7
2 周2003 63~88 男62;女42 通窍益智汤 脑复康、尼莫地平 120 中医药学会 6
3 林2003 62~87 男26;女34 调心方 多奈哌齐 84 MMSE 8
4 林2003 62~87 男26;女34 补肾方 多奈哌齐 84 MMSE 8
5 林2003 62~87 男26;女34 调心方 多奈哌齐 84 ADL 8
6 林2003 62~87 男26;女34 补肾方 多奈哌齐 84 ADL 8
7 方2003 57~87 男26;女14 通郁汤 脑复康 缺 中医药学会 9
8 韩2002 缺 男41;女20 活血益智汤 脑复康、维生素C 56 中医药学会 4
9 董2002 55~82 男64;女36 益智健脑颗粒 脑复康 84 自拟 10
10 李2002 56~74 男32;女23 脑复益聪胶囊 脑复康 90 MMSE 11
11 李2002 56~74 男32;女23 脑复益聪胶囊 脑复康 90 ADL 11
12 李2002 56~74 男32;女23 脑复益聪胶囊 脑复康 90 中医药学会 11
13 高2001 59~86 男35;女25 脑复清胶囊 脑通 90 MMSE 12
14 袁2001 60~83 男155;女60 益肾健脑汤 谷维素、西比灵、γ-氨酪酸 42~56 中医药学会 5
15 刘2001 60~89 男12;女23 加味当归芍药散 石杉碱甲 56 HDS-R 13
16 杨2001 56~74 男116;女40 补肾健脑丸 维生素C 150~240 中医药学会 14
17 缪2000 54~85 男47;女39 党参、黄芪、何首乌、山萸肉、当归 胞二磷胆碱、脑复康 60 MMSE 15
18 张2000 65~79 男25;女20 益智防呆冲剂 脑复康 120 MQ 16
19 顾2000 52~91 男22;女26 养心健脑方 脑复康 90 HDS-R 17
20 顾2000 52~91 男22;女26 养心健脑方 脑复康 90 ADL 17
21 李2000 60~82 男21; 女34 调心方 他克林 84 MMSE 18
22 李2000 60~82 男21;女34 调心方 红糖水 缺 MMSE 18
23 李2000 60~82 男21;女34 调心方 他克林 缺 FOM 18
24 李2000 60~82 男21;女34 调心方 红糖水 缺 FOM 18
25 胡1999 50~80+ 男18;女12 补肾泻浊汤 维生素E 60~90 自拟积分法 19
26 王1998 60~86 男61;女29 地黄饮子加减 尼莫地平、脑复康 30 中医药学会 20
27 朱1998 57~88 男40;女26 自拟中药（疏肝解郁滋肾养心） 脑复康 90 中医药学会 21
28 肖1997 缺 男99;女30 益肾通络颗粒 脑复康 缺 中医药学会 22
29 吴1997 51~96 男116;女49 益智健身精 脑复康 60 中医药学会 23
30 王2001 60~89 男82;女28 左归饮加减 尼莫地平、康脑灵 缺 中医药学会 24
31 杨2001 58~82 男36;女2 黄芪注射液或肾气丸 脑复新 15 缺 25
32 李2001 60~78 男28;女20 醒脑液 脑复康 90 BSSD,CGI 26
33 王2002 60~78 男41;女19 七福饮加味 脑复康 60 中医药学会 27
34 孟2002 60~83 男59;女47 清脑方 胞二磷胆碱、脑复康 30 MMSE 28
35 门2002 49~75 男96;女52 海龙健脑胶囊 都可喜 60 中医药学会 29
36 李2002 60+ 男96;女52 加味补阳还五汤 脑复新 84 中医药学会 30
37 周2003 68±9.5 男20;女23 白虎汤加减 都可喜 60~120 MQ 31
38 周2003 68±9.5 男20;女23 白虎汤加减 都可喜 60~120 IQ 31
39 李2001 60~79 男43;女7 加味还少丹 喜得镇 60 中医药学会 32
40 卢1999 60~84 男14;女16 自拟中药（补肾填精化痰开窍） 吉洛特 60~120 缺 33

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效应量指标 Cochran's Q 自由度 P值
Odds ratio 123.39 39 ＜0.000 1
Risk difference 281.82 39 ＜0.000 1

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模型 比值比 95%可信区间 可信区间上下限之差
固定效应模型 3.289 3 2.732 5~3.959 6 1.227 1
随机效应模型 3.238 1 2.300 8~4.557 4 2.256 6

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排除的研究 比值比 下限 上限
1 3.319 1 2.348 3 4.691 1
2 3.235 4 2.271 5 4.608 3
3 3.352 1 2.377 4 4.726 4
4 3.371 8 2.396 6 4.743 7
5 3.322 6 2.348 7 4.700 3
6 3.322 6 2.348 7 4.700 3
7 3.211 4 2.267 7 4.547 7
8 3.254 6 2.289 3 4.626 9
9 3.218 3 2.262 4.578 8
10 3.288 3 2.316 4 4.667 9
11 3.286 9 2.315 5 4.665 8
12 3.257 6 2.292 8 4.628 5
13 3.318 9 2.346 4.695 4
14 2.873 6 2.203 4 3.747 5
15 3.319 1 2.348 3 4.691 1
16 3.090 2 2.203 1 4.334 5
17 3.283 2.308 6 4.668 7
18 3.322 7 2.349 6 4.699
19 3.111 7 2.212 4 4.376 4
20 3.181 4 2.262 4.474 5
21 3.275 6 2.312 2 4.640 2
22 3.174 6 2.247 6 4.484
23 3.229 2 2.279 7 4.574 3
24 3.167 5 2.243 5 4.471 9
25 3.218 7 2.271 9 4.559 9
26 3.120 9 2.212 4 4.402 5
27 3.173 9 2.238 5 4.500 4
28 3.156 2 2.227 7 4.471 5
29 3.296 6 2.319 4.686 1
30 3.252 4 2.281 7 4.636
31 3.204 5 2.260 7 4.542 4
32 3.245 3 2.287 4.605 2
33 3.247 7 2.287 4 4.611 2
34 3.222 2.264 5 4.584 5
35 3.346 5 2.367 3 4.730 7
36 3.195 1 2.258 9 4.519 2
37 3.217 9 2.268 7 4.564 3
38 3.310 7 2.337 9 4.688 3
39 3.311 9 2.341 4 4.684 7
40 3.243 5 2.288 3 4.587 6

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亚组分类标准 亚组 Cochran's Q 自由度 P
出版年份 2002年以前 83.880 4 21 0.000 0
2002年（含）以后 18.280 7 17 0.371 3
控制组 安慰剂 0.041 2 2 0.979 6
非神经传导介质类药物 36.394 5 22 0.050 2
神经传导介质类药物 3.528 2 7 0.832 2
混合多重用药 43.873 9 5 0.000 0
试验设计 试验性研究 67.923 1 31 0.000 0
比较性研究 49.798 2 7 0.000 0
疗效评定标准 迷你心智状态检查表 9.5 7 0.218 7
中医药学会 76.9 14 0.000 0

"

亚组分类标准 亚组 比值比 95%可信区间
出版年份 2002年以前 4.76 2.77~8.18
2002年（含）以后 2.11 1.59~2.78
控制组 安慰剂 12.41 6.16~24.98
非神经传导介质类药物 3.10 2.30~4.18
神经传导介质类药物 1.20 0.73~1.97
混合多重用药 7.00 1.21~40.45
试验设计 试验性研究 2.92 2.10~4.07
比较性研究 4.38 1.62~11.85
疗效评定标准 迷你心智状态检查表 1.86 1.12~3.09
中医药学会 4.79 2.57~8.98
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[13] Liang-ping Hu, Xiao-lei Bao. Three-factor designs unable to examine the interactions (Part 2). Journal of Chinese Integrative Medicine, 2012, 10(11): 1229-1232.
[14] Hui-min Liu, Xian-bo Wang, Yu-juan Chang, Li-li Gu. Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis. Journal of Chinese Integrative Medicine, 2012, 10(11): 1211-1228.
[15] Liang-ping Hu, Xiao-lei Bao. Three-factor designs unable to examine the interactions (Part 1). Journal of Chinese Integrative Medicine, 2012, 10(10): 1088-1091.
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