"Buyi Ganshen", Ib qho tshuaj suav tshuaj kho mob, ua ke nrog Dopa Kev Npaj Rau Kev Kho Mob Parkinson: Kev Ntsuas Meta-Kev Ntsuas Ntawm Randomized Tswj Kev sim

Yog xav paub ntxiv:ali.ma@wecistanche.com

Xiao Qian Hao, Wen-Wen Si, Ye Tian, ​​Jie Liu, Yi-Chun Ji, Xin Rong Li, Zi-Feng Huang, Yu Zhu, Dong-Feng Chen, Wei-Hong Kuang, Mei-Ling Zhu

1 Shenzhen Tsev Kho Mob ntawm Integrated Traditional Suav thiab Western Tshuaj, Guangzhou University of suav tshuaj, Shenzhen 510800, Suav teb

2 Traditional suav tshuaj Innovation Center, Shenzhen Baoan tsoos suav tshuaj Tsev Kho Mob, Guangzhou University of suav tshuaj, Shenzhen 518000, Suav teb

3 Department of Anatomy, Lub Chaw Tshawb Fawb Txog Kev Siv Tshuaj Kho Mob, Guangzhou University of Chinese Medicine, Guangzhou 510006, Suav

4 Lub Tsev Kawm Ntawv Kho Mob Thib Ob, Guangdong Medical University, Dongguan 523808, Suav

Qhov tseem ceeb

Tsoos suav tshuaj Buyi Ganshen kev kho mob ua ke nrog kev npaj dopa hauv kev kho ntawmTus kab mob Parkinsontuaj yeem txhim kho kev nyab xeeb thiab kev ua tau zoo dua piv nrog dopa npaj ib leeg. Lub tswv yim meej ntawm yuav ua li cas Buyi Ganshen ua haujlwm ua ke nrog kev npaj dopa tseem tsis tau paub thiab qhov zoo ntawm cov ntawv sau npe yog qhov tsis txaus, tab sis nws tuaj yeem muab cov ntaub ntawv siv hauv kev kho mob thiab kev tshawb fawb ntxiv.

Abstract

Keeb kwm: Tshawb nrhiav kev cuam tshuam ntawm "Buyi Ganshen", ib qho tshuaj suav tshuaj uas feem ntau siv hauv "Tonifying lub siab thiab lub raum", ntxiv dopa npaj rau kev kho mob ntawmTus kab mob Parkinson. Cov txheej txheem: Qhov kev tshuaj ntsuam meta no tau tshuaj xyuas cov ntaub ntawv uas twb muaj lawm los ntawm kev tshawb nrhiav 7 cov ntaub ntawv hluav taws xob (CNKI, WanFang, EMBASE, PubMed, Medline, Cochrane Library, thiab VIP database) txij thaum pib mus txog rau lub Kaum Ob Hlis 2019. Randomized tswj kev sim ntsuas qhov cuam tshuam ntawm "Buyi Ganshen "ua ke nrog kev npaj dopa rau Parkinson tus kab mob tau txheeb xyuas. Cov txiaj ntsig tseem ceeb yog qhov ua tau zoo ntawm kev kho mob, UPDRS I (cov qhab nia ntawm lub hlwb), kev sib koom ua ke tag nrhoTus kab mob Parkinsonrating scale qhab nia, UPDRS III (motor qhab nia), UPDRS II (kev ua ub no ntawm lub neej txhua hnub), thiab UPDRS IV (cov teeb meem ntawm kev kho mob). Cov txiaj ntsig ntawm subordinate yog SPOCA-AUT cov qhab nia, cov tshuaj suav tshuaj suav tshuaj, thiab lwm yam kev phiv. Tus Thawj Saib Xyuas Kev Ntsuam Xyuas 5.3 tau siv los suav cov txiaj ntsig kwv yees. Cov txiaj ntsig tau pom tias yog qhov sib piv nrog rau 95 feem pua ​​​​ntawm kev ntseeg siab. Tus qauv ruaj los yog random raug xaiv raws li qib ntawm homogeneity ntawm cov kws tshawb fawb. I2 tau siv los txheeb xyuas qhov sib txawv. Qhov zoo ntawm kev tshawb fawb kuj tau soj ntsuam. Cov txiaj ntsig: Cov kev tshuaj ntsuam meta suav nrog 2,241 tus neeg los ntawm tag nrho ntawm 30 kev tshawb fawb. Cov ntaub ntawv no qhia tias kev kho mob ntawmTus kab mob Parkinsonnrog kev sib xyaw ntawm "Buyi Ganshen" thiab dopa npaj tau zoo dua piv rau dopa npaj ib leeg. Xaus: "Buyi Ganshen" ua ke nrog kev npaj dopa muaj nyob rau hauv qee qhov kev kawm, txhawm rau txhim kho kev nyab xeeb thiab kev ua tau zoo ntawm kev kho tus kab mob Parkinson, piv nrog dopa npaj ib leeg. Raws li feem ntau ntawm cov kev tshawb fawb suav nrog tsis zoo, qhov kev txiav txim siab no yuav tsum tau txiav txim siab ceev faj. Yog li, ntau ntau lub chaw, ua tau zoo, yav tom ntej randomized tswj kev sim nrog loj txaus cov qauv yuav tsum tau ntxiv illumination ntawm "Buyi Ganshen" ua ke nrog dopa npaj rauTus kab mob Parkinson.

Ntsiab lus:Tus kab mob Parkinson, Buyi Ganshen, Dopa npaj, Meta-analysis

Nyem rau cistanche hmoov cov txiaj ntsig kev noj qab haus huv rau tus kab mob Parkinson

Keeb kwm

Parkinson's disease (PD), qhov thib ob feem ntau cov kab mob neurodegenerative nyob hauv lub ntiaj teb, yog ib qho kab mob neurodegenerative maj mam txuas nrog cov tsis muaj lub cev muaj zog thiab lub cev muaj zog uas cuam tshuam rau lub neej zoo [1]. Kev tshawb fawb loj hlob tau qhia tias qhov tshwm sim ntawm PD yog li ntawm 3.5 feem pua ​​​​mus rau 42.8 feem pua ​​​​thiab nce siab nyob rau ob peb xyoos dhau los [2], thiab qhov tshwm sim thoob ntiaj teb ntawm PD yuav tsum ncav cuag 13 lab los ntawm 2040 [3].

Dopamine npaj tau yog cov tshuaj tseem ceeb rau kev kho PD txij li xyoo 1975 [4]. Thaum lub sij hawm, kev kho mob mus sij hawm ntev ntawm kev npaj dopa yog txuas ntxiv nrog cov teeb meem tsis sib haum xeeb xws li dyskinesia choreoathetosis, thiab kev hloov pauv hauv lub cev muaj zog [5]. Nrog rau kev loj hlob ntawm PD, cov tsos mob uas tsis yog lub cev muaj zog xws li kev paub tsis meej, kev hnov ​​​​lus txawv txav, kev ua haujlwm tsis zoo, kev puas siab puas ntsws, thiab kev pw tsaug zog tau dhau los ua qhov pom tseeb, uas cuam tshuam rau lub neej zoo ntawm cov neeg mob thiab ua rau lawv txoj kev tuag [6] ].

Txoj kev kho ntawm cov tshuaj suav tshuaj (TCM) rau PD yog paub tshwj xeeb. TCM tuaj yeem rov qab mus rau qhov ntxov tshaj plaws uas muaj nyob hauv Suav tshuaj ntsuab tshuaj ntsuab Huangdi Neijing (Inner Canon ntawm Yellow Emperor, 221 BCE-220 CE) hauv Suav teb [7]. Txog tam sim no, TCM tseem nrov hauv kev kho mob ntawm PD tshwj xeeb hauv cov tebchaws Esxias [8]. "Buyi Ganshen" (BYGS) yog ntau hom tshuaj suav tshuaj sib xyaw ua ke ntawm "Tonifying Liver thiab Regulating raum" (qhov no txhais tau tias "Buyi Ganshen"). BYGS feem ntau siv rau kev kho mob ntawm PD ua ke nrog kev npaj dopa hauv Suav teb, uas tuaj yeem pab txo qis cov tsos mob ntawm PD [9].

Nyob rau hauv tsab xov xwm no, ib qho kev tshuaj ntsuam xyuas meta yog ua los ntsuam xyuas cov teebmeem kev kho mob thiab kev nyab xeeb ntawm BYGS siv ua ke nrog dopa npaj rau PD kev kho mob los tshawb xyuas seb nws puas tuaj yeem txhim kho cov teebmeem ntawm kev kho mob ntawm PD, thiab txo cov kev mob tshwm sim.

Cov txheej txheem

Lub tswv yim tshawb nrhiav cov ntaub ntawv

Plaub tus neeg tshawb nrhiav (Xiaoqian Hao, Zifeng Huang, Yu Zhu, thiab Wenwen Si) ntawm nws tus kheej tshawb nrhiav CNKI, WanFang, EMBASE, PubMed, Medline, Cochrane Library, thiab Suav Science thiab Technique Journals Database (VIP) kom tau txais txhua yam kev sim [10]. Tag nrho cov ntawv tau tshaj tawm ua ntej Lub Kaum Hli 2019. Peb ua hauj lwm Cov Ntsiab Lus Kho Mob (MeSH) cov lus cog lus nrog cov ntawv dawb raws li cov lus tshawb nrhiav hauv qab no: ("Buyi Ganshen" OR "Zibu Ganshen" OR "Buyi Ganshen thiab dopa npaj" LOSSIS "Zibu Ganshen thiab dopa npaj") THIAB ("Parkinson's disease" LOSSIS "tremor syndrome"). Thaum muab cov ntaub ntawv suav nrog cov ntsiab lus no tau muab txhais ua Suav. Cov lus tshaj tawm ntawm tag nrho cov ntawv yog Suav thiab Askiv nkaus xwb.

Cov ntsiab lus suav nrog thiab cais tawm

Cov txheej txheem suav nrog. Hom kab ntawv: cov khoom tau raug randomized tswj kev sim (RCTs) uas ntsuas qhov cuam tshuam ntawm BYGS txuas nrog dopa npaj hauv kev kho mob ntawm PD, tsis hais txog kev kho mob li cas.

Cov neeg koom nrog: raws li UK Brain Bank cov txheej txheem [11], Suav National Diagnosis Standard hloov tshiab xyoo 2006 rau PD [12], Suav National Diagnosis Standard rau PD hauv xyoo 1984 [13], lossis lwm yam qauv sib piv, cov neeg koom tau lees paub kuaj mob nrog PD tsis hais hnub nyoog thiab poj niam txiv neej.

Hom kev cuam tshuam: PD tau kho los ntawm BYGS ua ke nrog kev npaj dopa. Kev kho mob uas suav nrog tsis muaj kev npaj dopa tsis tau sau npe.

Hom kev ntsuam xyuas: cov txiaj ntsig tseem ceeb yog qhov ua tau zoo ntawm kev kho mob, tag nrho cov qhab nia ntawm Kev Kho Mob Parkinson's Disease Rating Scale (UPDRS), UPDRS I (cov qhab nias siab), UPDRS III (motor qhab nia), UPDRS II (kev ua ub no ntawm lub neej txhua hnub), thiab UPDRS IV ( Cov teeb meem ntawm kev kho mob), cov txiaj ntsig ntawm subordinate yog SPOCA-AUT cov qhab nia, TCM syndromes, thiab kev tsis zoo.

Kev cais tawm. Cov ntawv tsis suav nrog txhua yam raws li cov hauv qab no: cov kev tshawb fawb uas tsis yog kho mob, tshuaj xyuas kev tshawb fawb, cov lus hais tsis yog lus Askiv lossis Suav; thiab tsiaj tej khoom; tsis tuaj yeem muab piv rau qhov sib npaug ntawm ob pawg; tsis muaj feem cuam tshuam cov txiaj ntsig hauv kev tshawb fawb; cov hnub muab rho tawm los ntawm cov kev tshawb fawb nrog luam tawm dua; cov neeg kawm tau mob siab rau lub siab thiab lub raum puas tsuaj ua ntej suav nrog hauv txoj kev tshawb no.

Cov ntaub ntawv tshuaj ntsuam thiab rho tawm cov ntaub ntawv

Peb tus kws tshuaj xyuas (Ye Tian, ​​Yichun Ji, thiab Dongfeng Chen) tau soj ntsuam cov kev tshawb fawb sau npe tag nrho ib leeg los ntawm kev tshuaj xyuas cov npe thiab cov lus piav qhia thiab tshem tawm cov ntawv uas tsis ua raws li cov txheej txheem suav nrog. Cov kws sau ntawv cov npe thiab cov tsev kawm tau ua rau qhov muag tsis pom kev rau tus neeg saib xyuas kom tsis txhob muaj kev xav. Los ntawm kev sib tham nrog tus thib peb xyuas, peb tshem tawm tag nrho cov kev tsis pom zoo (Meiling Zhu). Peb rho tawm cov ntaub ntawv hauv qab no los ntawm txhua cov ntawv sau: thawj tus sau, xyoo tshaj tawm, cov neeg mob lub hnub nyoog, tus qauv loj, chav kawm ntawm tus kab mob, chav kho mob, ntsuas qhov tshwm sim, thiab cov ntsiab lus cuam tshuam.

Kawm kev soj ntsuam zoo

Peb tus kws tshawb fawb (Liu Jie, Xinrong Li, thiab Weihong Kuang) tau soj ntsuam cov txheej txheem zoo ntawm kev sim ib leeg siv Cochrane Collaboration pheej hmoo ntawm kev tsis ncaj ncees, ntawm cov khoom hauv qab no: tus neeg koom; tus kws kho mob; faib zais cia; tiam ib ntus; cov ntaub ntawv tsis tiav, thiab cov txiaj ntsig ntsuas qhov muag tsis pom; xaiv cov txiaj ntsig qhia; thiab lwm qhov chaw ntawm kev tsis ncaj ncees [14] Txhua lub npe tuaj yeem suav tau 3 pawg xws li "ntxiv" (tsis tshua muaj kev tsis ncaj ncees), "-" (muaj kev pheej hmoo siab ntawm kev tsis ncaj ncees), lossis "? Yog tias muaj kev tsis pom zoo, peb daws nws los ntawm kev sab laj nrog tus kws tshawb fawb thib peb (Meiling Zhu).

Cov ntaub ntawv synthesis thiab statistical tsom xam

Meta-analysis raug tua nrog Tus Thawj Saib Xyuas Kev Ntsuam Xyuas 5.3 (cochrane Collaboration, UK). Qhov sib txawv nruab nrab (MD) thiab qhov sib txawv ntawm qhov sib txawv (OR) nrog 95 feem pua ​​​​ntawm kev ntseeg siab (CI) ntawm txoj kev tshawb no tau suav. Kev txheeb xyuas heterogeneity ntawm cov txiaj ntsig thoob plaws kev sim tau ntsuas los ntawm Chi-square-based Q-statistic test, thiab qhov tsis sib xws tau suav los ntawm I2. Yog tias homogeneity (P Ntau dua lossis sib npaug rau 0.1, I2 Tsawg dua lossis sib npaug rau 50 feem pua ​​) muaj, cov ntsiab lus OR thiab 95 feem pua ​​​​CI tau suav los ntawm cov qauv kev cuam tshuam. Yog tias tsis yog, tus qauv random-effects tau siv thaum P <0.1,i2> 50 feem pua. Tsis tas li ntawd, kev soj ntsuam rhiab heev yuav tsum tau ua los nrhiav seb qhov twg ntawm ib txoj kev tshawb fawb tau cuam tshuam rau cov txiaj ntsig sib sau. Cov phiaj xwm funnel tau siv los ntsuas kev tsis ncaj ncees ntawm kev tshaj tawm.

Cov txiaj ntsig

Kev piav qhia ntawm cov txheej txheem tshuaj ntsuam

Peb siv PRISMA flow diagram (Daim duab 1) los sau cov txheej txheem soj ntsuam kom ntxaws. Peb cov kev tshawb fawb tshawb fawb tau sau npe 128 cov kev tshawb fawb hauv CNKI, WanFang, Medline, Embase, PubMed, CENTRAL, VIP databases, thiab kev tshawb nrhiav phau ntawv. Tag nrho ntawm 104 kab lus raug tshuaj xyuas raws li lub npe thiab kev paub daws teeb meem, thiab cov khoom raug muab rov qab tom qab tshem tawm cov duplicates. Tom qab ntawd peb tshem tawm 48 cov kev tshawb fawb uas tsis ua raws li peb cov txheej txheem suav nrog, suav nrog 5 kev tshawb fawb tsiaj, 7 txoj kev tshawb fawb txog kev tshawb fawb, 28 tsis yog PD, thiab BYGS cov kev tshawb fawb, thiab 8 kev tshuaj xyuas. Tsib caug-rau kab lus raug soj ntsuam nrog tag nrho cov ntawv nyeem. Tom qab ntawd, peb tshem tawm 26 qhov kev tshawb fawb los ntawm cov laj thawj hauv qab no: 10 qhov kev tshawb nrhiav tsis tsim nyog, 8 cov ntaub ntawv tsis txaus, thiab 8 cov kev tshawb fawb tsis yog RCTs. Thaum kawg, tag nrho 30 txoj kev tshawb fawb [15–44] tseem nyob thiab tau tso npe rau hauv peb qhov kev tshuaj ntsuam meta.

Kawm yam ntxwv

Cov yam ntxwv dav dav ntawm cov kev tshawb fawb sau npe tau sau tseg nyob rau hauv Table 1. Tag nrho 2,241 cov neeg koom nrog koom nrog kev tshuaj ntsuam xyuas, nrog rau cov qauv piv txwv xws li 27 [15] rau cov neeg 180 [16] nrog PD. Qhov nruab nrab hnub nyoog ntawm cov neeg mob hauv cov kev tshawb fawb no muaj li ntawm 35 txog 80 xyoo. Lub sijhawm nruab nrab PD tau tshaj tawm hauv cov kev tshawb fawb no ntawm 1 txog 32 xyoo. Tag nrho cov kev tshawb fawb luam tawm hauv Suav yog los ntawm Tuam Tshoj thiab xa mus rau ta oa ob sab caj npab tsim: ib pawg tswj hwm thiab ib pab pawg sim. Pawg Tswjhwm tau muab dopa npaj kev kho nkaus xwb thiab pab pawg sim yog BYGS txoj kev kho ntxiv rau dopa npaj kho.

Clinical efficiency

Clinical curative efficiency. Kaum yim qhov kev sim [18–35] nrog rau tag nrho 1,275 tus neeg mob tau pom kev kho mob zoo. Qhov ntsuas qis qis ntawm cov kev tshawb fawb qhia los ntawm kev ntsuas heterogeneity (Chi2=20.41, P=0.25, I2=17 feem pua ​​). Qhov sib xyaw OR thiab 95 feem pua ​​CI raws li 3.77 (2.82, 5.06), P < 0.00001="" tau="" suav="" los="" ntawm="" tus="" qauv="" kev="" cuam="" tshuam="" ruaj="" khov,="" taw="" qhia="" txog="" qhov="" sib="" txawv="" ntawm="" cov="" pab="" pawg="" ntawm="" dopa="" npaj="" ib="" leeg="" thiab="" bygs="" ua="" ke="" nrog="" kev="" npaj="" dopa.="" qhov="" no="" qhia="" tau="" hais="" tias="" piv="" rau="" kev="" npaj="" dopa="" ntshiab,="" bygs="" ua="" ke="" nrog="" kev="" npaj="" dopa="" tuaj="" yeem="" txhim="" kho="" kev="" kho="" mob="" zoo="" (daim="" duab="">

UPDRS cov qhab nia. UPDRS I: 8 kev tshawb fawb [16, 19, 32–37] nrog rau tag nrho 745 tus neeg mob tau kaw UPDRS I. Qhov tshwm sim ntawm qhov kev xeem heterogeneity (Chi2=74.32, P < 0.{{13}="" }0001,="" i2="91" feem="" pua="" ​​)="" tau="" qhia="" txog="" qhov="" tseem="" ceeb="" ntawm="" qhov="" sib="" txawv="" ntawm="" cov="" khoom,="" tus="" qauv="" random-ffects="" tau="" siv="" los="" tshuaj="" xyuas.="" md="" thiab="" 95="" feem="" pua="" ​​​​ci="" yog="" −0.28="" (−0.46,="" −0.10),="" p="0.002," qhia="" txog="" qhov="" sib="" txawv="" tseem="" ceeb="" ntawm="" ob="" pawg="" (daim="" duab="" 3a).="" qhov="" no="" qhia="" tias="" bygs="" ua="" ke="" nrog="" kev="" npaj="" dopa="" tuaj="" yeem="" txo="" qis="" updrs="">

UPDRS II: 10 kev tshawb fawb [16, 18, 19, 21, 25, 32–34, 36, 37] nrog rau tag nrho ntawm 870 cov neeg mob soj ntsuam UPDRS II. Meta-analysis ntawm 10 kev sib piv tau qhia tias BYGS ua ke nrog dopa npaj txo qis UPDRS II (heterogeneity: Chi2=159.34, P < 0.00001,="" i{17}}="" feem="" pua;="" md:="" −3.27,="" 95="" feem="" pua="" ​​ci="" −="" 4.56="" rau="" −1.98,="" p=""><0.00001; daim="" duab="" 3b)="" piv="" nrog="" rau="" pawg="" tswj="">

UPDRS III: 11 tsab xov xwm [16, 19–21, 25, 32–37] tau qhia tias kev sim heterogeneity (Chi2=49.06, P < 0.00001,="" i{{="" 11}}="" feem="" pua="" ​​)="" qhia="" txog="" qhov="" muaj="" txiaj="" ntsig="" zoo="" ntawm="" cov="" khoom="" sib="" txawv,="" cov="" qauv="" kev="" cuam="" tshuam="" tau="" raug="" siv="" los="" tshuaj="" xyuas.="" tus="" naj="" npawb="" ntawm="" md="" thiab="" 95="" feem="" pua="" ​​ci="" yog="" −2.82="" (−3.84,="" −1.80),="" p="">< 0.00001,="" qhia="" txog="" qhov="" sib="" txawv="" ntawm="" ob="" pawg="" (daim="" duab="" 3c).="" qhov="" no="" qhia="" tau="" tias="" bygs="" ua="" ke="" nrog="" kev="" npaj="" dopa="" tuaj="" yeem="" txo="" qis="" updrs="">

UPDRS IV: meta-analysis ntawm 6 kev tshawb fawb [16, 19, 21, 33, 36, 37] nrog rau tag nrho ntawm 609 cov neeg mob tau qhia tias BYGS ua ke nrog kev npaj dopa tuaj yeem txo qis UPDRS IV piv nrog dopa Kev npaj nkaus xwb (heterogeneity: Chi2=89.37, P < 0.00001, I2=94 feem pua ​​; MD: −1.40, 95 feem pua ​​CI: −1.83 rau − 0.96, P < 0.00001; Daim duab 3D).

Tag Nrho UPDRS cov qhab nia: 17 kab lus [16, 19, 26, 27, 29–34, 37–43] nrog rau tag nrho ntawm 1,387 tus neeg mob tau qhia tias BYGS ua ke nrog kev npaj dopa tuaj yeem txo qis tag nrho UPDRS tus qhab nia piv nrog kev npaj dopa nkaus xwb (heterogeneity : Chi2=127. 5.83, P < 0.00001; Daim duab 3E).

SPOCA-AUT qhab nia.

Plaub qhov kev tshawb fawb [33, 37, 41, 42] tau soj ntsuam SPOCA-AUT qhab nia hauv 334 tus neeg mob. Cov txiaj ntsig tau tshaj tawm tias muaj kev txheeb cais sib txawv ntawm cov ntawv (Chi2=9.16, P=0.03, I2=67 feem pua, MD thiab 95 feem pua ​​​​CI li −4.26 (−5.48, −3.05) Kev soj ntsuam rhiab heev los nrhiav cov hauv paus ntsiab lus ntawm heterogeneity.Qhov kev sim [17] muaj cov kev kho mob sib txawv los ntawm peb qhov kev tshawb fawb. Kev npaj nkaus xwb (MD: −3.68, 95 feem pua ​​CI: −4.38 txog −2.98, P <0.00001; heterogeneity:="" chi2="1.98," p="0.37," i2="0" feem="" pua="" ​​)="" tom="" qab="" so="" tawm="" qhov="" kev="" sim,="" qhov="" no="" qhia="" tias="" bygs="" ua="" ke="" nrog="" kev="" npaj="" dopa="" yuav="" txo="" tau="" spoca-aut="" cov="" qhab="" nia="" los="" txhawb="" lub="" neej="" zoo="" piv="" nrog="" kev="" kho="" ntawm="" dopa="" npaj="" ib="" leeg="" (daim="" duab="">

TCM Syndrome. Kaum qhov kev tshawb fawb [17, 18, 22, 31, 32, 4{{10}}}-44] suav nrog 676 tus neeg mob los ntsuas qhov hloov pauv ntawm TCM syndromes. Qhov kev ntsuam xyuas heterogeneity pom Chi2=255.64, P < 0.00001,="" thiab="" i{12}}="" feem="" pua="" ​​,="" qhia="" txog="" qhov="" muaj="" txiaj="" ntsig="" ntawm="" kev="" txheeb="" cais="" ntawm="" cov="" ntawv.="" md="" thiab="" 95="" feem="" pua="" ​​​​ci="" yog="" −7.31="" (−9.93,="" −4.70),="" p="">< 0.00001.="" qhov="" no="" qhia="" tau="" hais="" tias="" bygs="" ua="" ke="" nrog="" dopa="" npaj="" rau="" kev="" kho="" mob="" ntawm="" pd="" tuaj="" yeem="" ua="" rau="" tcm="" syndromes="" zoo="" heev="" (daim="" duab="">

Cov xwm txheej tsis zoo

Xya kab lus [18–20, 26, 27, 30, 38] suav nrog 423 tus neeg mob, tau tshaj tawm cov xwm txheej tsis zoo. Qhov kev ntsuam xyuas heterogeneity tau pom Chi2=9.58, P=0.14, I2=37 feem pua ​​​​hauv kev tshuaj ntsuam meta, tawm tswv yim tias tsis muaj kev txheeb xyuas qhov sib txawv ntawm cov kev tshawb fawb, yog li cov teeb meem ruaj khov tus qauv los xam qhov sib xyaw OR thiab 95 feem pua ​​​​CI, uas yog 0.32 (0.18, 0.58), P=0.0001 (Daim duab 6), qhia tias qhov sib txawv ntawm ob pawg, uas piav qhia tias BYGS kev kho mob ua ke nrog kev npaj dopa hauv kev kho mob ntawm PD tuaj yeem txo cov xwm txheej tsis zoo thaum piv nrog dopa npaj ib leeg.

Risk ntawm Bias

Txhawm rau ntsuas qhov kev pheej hmoo ntawm kev tsis ncaj ncees rau txhua qhov kev tshawb fawb uas tau sau npe, peb tau tshuaj xyuas cov kev cuam tshuam los ntawm kev siv cov lus qhia ntawm Cochrane Phau Ntawv [14]. 21 ntawm 30 cov ntawv sau npe [15–17, 19, 21, 22, 24, 26–29, 31–36, 38, 41, 42, 44] tau piav qhia txog qhov randomization, tab sis tsis muaj txoj hauv kev ntawm randomization tau hais. Tsuas yog 9 txoj kev tshawb fawb [18, 20, 23, 25, 30, 37, 39, 40, 43] tau tshaj tawm txoj kev randomization. Tsuas yog ib txoj kev tshawb fawb [39] tau piav qhia txog qhov muag tsis pom ntawm cov neeg koom nrog thiab cov neeg ua haujlwm, tag nrho lwm cov kev tshawb fawb tsis tau piav qhia txog cov neeg ua haujlwm, kev faib zais cia, kev ntsuam xyuas cov txiaj ntsig, thiab kev qhia xaiv. tsis muaj cov ntaub ntawv tshwm sim tsis tiav thiab lwm qhov chaw ntawm kev tsis ncaj ncees, yog li peb suav tias lwm qhov kev tsis ncaj ncees yog qhov pheej hmoo tsawg (Daim duab 7 thiab daim duab 8).

Kev Tshawb Fawb Tshaj Tawm Txog Kev Ncaj Ncees

Daim duab 9–11 qhia txog cov phiaj xwm funnel uas los ntawm cov khoom nrog cov ntaub ntawv ntawm kev kho mob zoo, UPDRS cov qhab nia, thiab TCM syndromes. Cov phiaj xwm funnel tau qhia tias tag nrho cov nodes yog asymmetrical, uas yuav cuam tshuam rau cov txiaj ntsig ntawm peb txoj kev tshawb fawb uas yuav muaj kev tsis ncaj ncees rau hauv peb cov kev tshawb fawb.

Kev sib xyaw ntawm BYGS

Table 2 qhia txog cov tshuaj muaj pes tsawg leeg ntawm BYGS. Lub hauv paus muaj pes tsawg leeg yog Heshouwu (Polygonum multiflorum Thunb), Guijia (Chinemys reevesii), Baishao (Paeonia lactiflora Pall), Shengdihuang (Rehmannia glutinosa Libosch), Shudihuang (Radix Rehmannia preparata), Danggui (Angelica), Rouccherongtic (C. (Fructus Corni), Chuanniuxi (Cyathula officinalis Kuan), Mudanpi (Paeonia suffruticosa Andr), Bajitian (Morinda Officinalis How), Sangjisheng (Taxillus Chinensis), Muli (Ostrea gigas Thunberg), Gouqi (Suav wolfberry). Cov tshuaj ntsuab no ua haujlwm ua ke los "txhawb lub siab thiab lub raum thiab tswj Yin thiab Yang" hauv TCM.

Kev sib tham

Cov ntsiab lus ntawm cov txiaj ntsig tseem ceeb

"Lub siab thiab lub raum tsis muaj peev xwm" yog feem ntau ua rau PD raws li Suav tshuaj [45], thiab ntxiv dysfunction ntawm lub cev xws li phlegm agglutination, Qi Stagnation, Spleen thiab plab hnyuv, thiab ntshav Stasis nws thiaj li ua rau zus tau tej cov PD. Yog li, lub hauv paus ntsiab lus tseem ceeb ntawm TCM txoj kev kho ntawm PD yog "Tonifying lub siab thiab raum" (qhov no yog lub ntsiab lus ntawm BYGS). Ib qho kev tshuaj ntsuam xyuas cov ntaub ntawv tau ua tiav uas txhawb nqa qhov ua tau zoo ntawm txoj kev kho no. Raws li kev pabcuam kev kho mob rau PD, BYGS ua ke nrog kev npaj dopa txo qis tag nrho UPDRS cov qhab nia, UPDRS I II III IV qhab nia, SPOCA-AUT qhab nia, thiab TCM syndromes tau qhab nia, thiab nce cov txiaj ntsig ntawm kev kho mob. Tsis tas li ntawd, cov neeg mob uas tau kho los ntawm BYGS ua ke nrog kev npaj dopa tau qhia txog cov xwm txheej tsis zoo.

Kev ntsuam xyuas ntawm BYGS formulation

Ntau cov ntawv tau qhia tias cov tshuaj muaj nyob rau hauv BYGS tso saib cov teebmeem neuroprotective hauv PD cov neeg mob. Nws ntseeg tau tias mitochondrial tsis ua haujlwm, oxidative kev nyuaj siab, o, protein misfolding thiab aggregation, thiab apoptotic cell tuag ua lub luag haujlwm tseem ceeb hauv PD pathogenesis, tab sis cov kab mob pes tsawg ntawm cov txheej txheem xaiv dopaminergic neurons poob hauv PD tseem dimness [46]. PD yog kev sib koom ua ke ntawm cov xwm txheej sib cuam tshuam tsis yog los ntawm kev ua haujlwm tsis zoo ntawm ib txoj hauv kev tshwj xeeb. Txoj kev loj hlob ntawm kev kho mob neuroprotective tsom mus rau ntau lub teeb liab txoj hauv kev yog qhov xav tau ceev ntawm kev kho mob PD [47]. Muaj qee qhov kev tiv thaiv PD ntawm cov khoom xyaw tseem ceeb ntawm cov tshuaj ntsuab hauv vivo lossis hauv vitro sim. Txoj kev tshawb no muaj catalpol uas tuaj yeem ua rau muaj kev ntxhov siab oxidative los ntawm kev txo qis cov pa oxygen reactive hom [48]. Lwm qhov kev tshawb fawb qhia tias cov khoom xyaw nquag ntawmEchinacoside (Cistanche deserticola)tso tawm kom muaj zog inhibition ntawm kev tsim khoom thiab / lossis kev nthuav qhia ntawm ntau yam pro-inflammatory cytokines, nrog rau cov qog necrosis factor-, interleukin (IL)-1 , nitric oxide, IL-1 , thiab IL{{4} } [49] ib. Lub 2,3,5,4′-Tetrahydroxystilbene-2-O- -D-Glucoside (Polygonum multiflorum Thunb) tuaj yeem ua rau mitochondrial tsis ua haujlwm los ntawm kev txwv qhov tsis muaj zog ntawm cellular ATP qib thiab mitochondrial membrane peev xwm [50]. n-Butylidenephthalide (Angelica) tau ua kom muaj peev xwm tiv thaiv apoptotic los ntawm inhibiting qhov nce ntawm qhov piv ntawm Bax/Bcl-2 thiab activating caspase-3 thiab caspase-8 [51]. Tsis tas li ntawd, peb tuaj yeem tshawb nrhiav qhov zoo tshaj plaws hauv kev sib xyaw ua ke rau cov tshuaj siv ntau zaus, thiab qhov no kuj tseem pom cov tshuaj ntsuab tshuaj kho mob rau cov neeg mob PD.

Qhov kev tshuaj ntsuam meta no pom tau tias BYGS txoj kev kho mob tiag tiag txhim kho cov txiaj ntsig kho mob thiab kev muaj sia nyob zoo. Tsis tas li ntawd, BYGS txo cov teebmeem tsis zoo. Txawm li cas los xij, tej zaum vim yog cov qauv me me, cov teebmeem me me ntawm E-rosette tau pom. Cov teebmeem no tuaj yeem hais txog cov ntsiab lus ntau dua los ntawm kev tshawb fawb loj yav tom ntej. Hauv luv luv, qhov kev tshuaj ntsuam no tau qhia txog kev nyab xeeb thiab kev ua tau zoo ntawm kev siv TCMBYGS ua ke nrog dopa npaj rau kev kho mob ntawm PD.

Kev txwv

Kev tshuaj xyuas meta yog qhov kev tshuaj xyuas tshiab txog kev kho BYGS ua ke nrog kev npaj dopa hauv kev kho cov neeg mob nrog PD. Cov txiaj ntsig ntawm peb qhov kev tshuaj ntsuam xyuas meta tau tso npe rau ntau qhov txiaj ntsig ntawm kev soj ntsuam kev ua tau zoo, kev soj ntsuam tus nqi teb, tag nrho UPDRS tus qhab nia, UPDRS IV, UPDRS III, UPDRS II, UPDRS I. Cov txiaj ntsig thib ob yog SPOCA-AUT qhab nia, TCM syndrome, thiab lwm yam. kev phiv tshuaj. Txawm li cas los xij, muaj qee qhov kev txwv ntawm qhov kev tshawb fawb no uas thaiv peb kom tsis txhob muaj cov lus xaus. Ua ntej, tsis muaj ib qho ntawm cov kev tshawb fawb suav nrog tau sau npe nyob rau hauv kev sim tshuaj ntsuam xyuas ua ntej tso npe kawm hauv txoj kev kawm [52]. Qhov thib ob, cov txheej txheem zoo ntawm RCTs rau npe yog feem ntau qis. Tag nrho cov ntawv sau npe tsis tau piav qhia txog qhov muag tsis pom ntawm qhov kev ntsuam xyuas qhov tshwm sim thiab kev faib zais zais. Tsuas yog ib qho kev sim [39] tau tshaj tawm txoj hauv kev ntawm kev tsis pom kev ntawm cov neeg koom thiab cov neeg ua haujlwm. Kev tshaj tawm tsis ncaj ncees tej zaum yuav muaj. Thib peb, cov txiaj ntsig kev tshawb fawb tuaj yeem txo qhov siv tau thiab kev ntseeg siab rau kev kho mob siab heterogeneity. Thaum kawg, lub tswv yim tshawb nrhiav yuav tsis pom tag nrho cov kev tshawb fawb cuam tshuam. Vim yog cov kev txwv saum toj no, kev tshawb fawb loj yuav tsum tau lees paub qhov kev tshawb fawb no.

Xaus

TCM BYGS kev kho mob ua ke nrog kev npaj dopa hauv kev kho mob ntawm PD tuaj yeem ua rau muaj kev tiv thaiv ntawm cov neeg mob txhawm rau txhim kho kev nyab xeeb thiab kev ua tau zoo. Tab sis qhov sib sib zog nqus-seed mechanism ntawm yuav ua li cas BYGS ua hauj lwm ua ke nrog dopa npaj tseem tsis tau paub thiab qhov zoo ntawm cov ntawv sau npe kuj tsis txaus. Yog li, nws yog qhov yuav tsum tau ua cov qauv loj dua, ntau qhov chaw, randomized, zoo siab, yav tom ntej, ob qhov muag tsis pom kev kuaj mob ntxiv los ntsuas qhov ua tau zoo ntawm BYGS thiab dopa npaj kho rau PD.

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