目的:系统评价银杏叶提取物注射液辅助治疗脑出血的疗效和安全性。方法:检索知网、万方、维普、SinoMed及PubMed、Embace、Cochrane Library等数据库从建库到2021年9月收录有关银杏叶提取物治疗脑出血的随机对照试验。Rev Man 5。4数据分析，结局指标的证据质量分级采用GRADE系统。结果:共检索文献192篇，最终纳入16篇文献，共1435例脑出血患者，其中试验组718例，对照组717例。Meta分析结果显示，同内科保守治疗相比，联用银杏叶提取物注射液，有以下几个方面的功效:①能提高临床有效率(RR=1。21，95％CI[1。14，1。29]，P<0。01);②能降低神经功能缺损评分(MD=-5。36，95％CI[-6。90，-3。81]，P<0。01;MD=-4。41，95％CI[-5。23，-3。60]，P<0。01);③能减小脑血肿体积(MD=-4。13，95％CI[-5。75，-2。51]，P<0。01);④能减小脑水肿体积(MD=-4。34，95％CI[-5。78，-2。90]，P<0。01);⑤能提高日常生活活动能力(ADL)(MD=11。99，95％CI[9。85，14。13]，P<0。01);⑥能改善蒙特利尔认知功能评分(MD=5。33，95％CI[2。53，8。13]，P<0。01);⑦能降低hs-CRP(MD=-6。03，95％CI[-10。26，-1。81]，P<0。01;IL-6的MD=-8。56，95％CI[-15。92，-1。20]，P<0。05;IL-8[MD=-10。99，95％CI[-13。14，-8。85]，P<0。01];TNF-α[MD=-18。26，95％CI[-34。31，-2。22]，P<0。05)];⑧在安全性方面，未发现联用银杏叶提取物注射液有增加不良反应的风险。同手术治疗相比，联用银杏叶提取物注射液，具有以下几个方面的优势:①能提高临床有效率(RR=1。30，95％CI[1。21，1。51]，P<0。01);②能提高卒中专用生活质量(SS-QOL)(MD=23。14，95％CI[14。06，32。21]，P<0。01);③能提高日常生活活动能力(MBI)(MD=11。39，95％CI[5。34，17。43]，P<0。01);④能降低炎症指标hs-CRP(MD=-0。66，95％CI[-0。95，-0。37]，P<0。01;IL-6[MD=-14。97，95％CI[-19。97，-9。98]，P<0。01)];TNF-α[MD=-16。12，95％CI[-20。68，-11。56]，P<0。01)]。结论:银杏叶提取物注射液联合西医常规治疗或手术治疗，对脑出血均有较好的疗效和安全性，可提高临床有效率、提高日常生活活动能力、提高卒中生活质量、改善蒙特利尔认知功能评分，降低脑水肿、脑血肿体积，降低神经功能缺损评分，降低炎症指标，且安全性较好。
Mate-Analysis of the Efficacy and Safety of Ginkgo biloba Extract Injection in Adjuvant Treatment of Cerebral Hemorrhage
Objective:To systematically evaluate the efficacy and safety of Ginkgo biloba extract (GBE) injection in the adjuvant treatment of cere-bral hemorrhage.Methods:Randomized controlled trials (RCTs) on the treatment of cerebral hemorrhage with GBE were retrieved from data-bases such as CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,and Cochrane Library from their inception to September 2021.Data a-nalysis was conducted using RevMan 5.4,and the quality of evidence for outcome indicators was graded using the GRADE system.Results:A total of 192 articles were retrieved,and 16 articles were finally included,covering 1435 patients with cerebral hemorrhage,including 718 in the experimental group and 717 in the control group.Meta-analysis results showed that compared with internal medical conservative treat-ment,the combined use of GBE injection could increase clinical efficacy (RR=1.21,95％ CI[1.14,1.29],P<0.01),decrease neurological deficit scores (MD=-5.36,95％ CI[-6.90,-3.81],P<0.01;MD=-4.41,95％ CI[-5.23,-3.60],P<0.01),reduce cerebral hematoma volume (MD=-4.13,95％ CI[-5.75,-2.51],P<0.01),decrease brain edema volume (MD=-4.34,95％ CI[-5.78,-2.90],P<0.01),improve activities of daily living (ADL) (MD=11.99,95％ CI[9.85,14.13],P<0.01),enhance Montreal Cognitive Assessment (MoCA) scores (MD=5.33,95％ CI[2.53,8.13],P<0.01),and reduce inflammatory indicators (MD=-6.03,95％ CI[-10.26,-1.81],P<0.01;MD=-8.56,95％ CI[-15.92,-1.20],P<0.05;MD=-10.99,95％ CI[-13.14,-8.85],P<0.01;MD=-18.26,95％ CI[-34.31,-2.22],P<0.05).In terms of safety,there was no increased risk of adverse reactions associated with the use of GBE injection.Compared with surgical treatment,the combined use of GBE injection could increase clinical efficacy (RR=1.30,95％ CI[1.21,1.51],P<0.01),improve Stroke-Specific Quality of Life (SS-QOL) scores (MD=23.14,95％ CI[14.06,32.21],P<0.01),enhance Modified Barthel Index (MBI) of ADL (MD=11.39,95％ CI[5.34,17.43],P<0.01),and reduce inflammatory indicators (MD=-0.66,95％ CI[-0.95,-0.37],P<0.01;MD=-14.97,95％ CI[-19.97,-9.98],P<0.01);MD=-16.12,95％ CI[-20.68,-11.56],P<0.01).Conclusion:GBE injection,when com-bined with conventional western medicine treatment or surgical treatment,exhibits favorable efficacy and safety in treating cerebral hemor-rhage.It can enhance clinical efficacy,ADL,stroke-specific quality of life,MoCA scores,reduce brain edema and hematoma volume,decrease neurological deficit scores,reduce inflammatory indicators,and maintain a good safety profile.
NETL
NSTL
万方数据
