Evidence-based evaluation of adjuvant therapy with Chinese medicine for cerebral small vessel disease: A systematic review and meta-analysis

Abstract

Background: As the population ages, the prevalence of cerebral small vessel disease (CSVD) steadily increases, resulting in a significant economic burden on society. In East Asian nations, Chinese medicine has been used extensively to teat CSVD and has been reported to improve the cognitive function of patients. The present study aimed to comprehensively assess the efficacy and safety of Chinese medicine as adjuvant therapy for CSVD.

Methods: A literature search of the CNKI, Wanfang, VIP, SinoMed, Medline, Cochrane Library, and ChiCTR databases were searched for RCTs investigating the use of TCM as an adjuvant in the treatment of CSVD, published up to July 27, 2023, was performed. Based on the Cochrane Collaboration Network bias risk assessment criteria, Review Manager version 5.3 was used to perform a meta-analysis.

Results: Meta-analysis of 27 RCTs, including 2554 subjects, revealed that the majority of the RCTs exhibited risk for ambiguous bias. The findings demonstrated that the use of Chinese medicine as an adjuvant treatment for CSVD effectively enhanced the cognitive function, as evidenced by improvements in the MMSE score (mean difference (MD) = 2.42, 95% confidence interval (CI) [1.79,3.17], P < .00001), MoCA score (MD = 2.39, 95% CI [1.78,2.99], P < .00001) and ADL score (MD = 4.13, 95% CI [1.74,6.51], P = .0007). Furthermore, the study also demonstrated the advantages of Chinese medicine adjuvant therapy in enhancing the Chinese medicine syndrome score (MD = -2.57, 95% CI [-3.31, -1.83], P < .00001), CRP (MD = -1.35, 95% CI [-2.27, -0.43], P = .004), Hcy (MD = -3.44,95% CI [-4.05, -2.83], P < .00001), and blood flow velocity (CBV) (MD = 1.37,95% CI [0.24,2.50], P = .02). Moreover, there was no statistical difference in the incidence of adverse reactions between the 2 groups.

Conclusion: Findings of the present study indicate that the Chinese medicine, as an adjuvant to conventional treatment, appeared to be efficacious in enhancing cognitive function, reducing Chinese medicine syndrome score, improving blood biochemical markers, and improving cerebral blood flow perfusion in patients with CSVD, without any notable adverse reactions. However, it is imperative to validate these conclusions in future high-quality investigations.

Figure 1.

Study selection process for the meta-analysis.

Figure 2.

Risk of bias graph.

Figure 3.

Risk of bias summary.

Figure 4.

Comparison of the clinical efficiency between Chinese medicine combined with conventional treatment conventional treatment alone in cognitive function. (A) MMSE score. (B) MoCA score. (C) ADL score. ADL = activities of daily living. MMSE = Mini Mental State Examination, MoCA = Montreal Cognitive Assessment.

Figure 5.

Comparison of the clinical efficiency between Chinese medicine combined with conventional treatment conventional treatment alone in NIHSS score. NIHSS = National Institute of Health Stroke Scale.

Figure 6.

Comparison of the clinical efficiency between Chinese medicine combined with conventional treatment conventional treatment alone in Chinese medicine syndrome score.

Figure 7.

Comparison of the clinical efficiency between Chinese medicine combined with conventional treatment conventional treatment alone in CRP level. CRP = C-reactive protein.

Figure 8.

Comparison of the clinical efficiency between Chinese medicine combined with conventional treatment conventional treatment alone in Hcy level. Hcy = homocysteine.

Figure 9.

Comparison of the clinical efficiency between Chinese medicine combined with conventional treatment conventional treatment alone in Cerebral blood flow perfusion.

Figure 10.

Meta-analysis of incidence of adverse reactions.

Figure 11.

Funnel plot of the comparison of publication bias. (A) MMSE. (B) MoCA. (C) ADL. ADL = activities of daily living, MMSE = Mini Mental State Examination, MoCA = Montreal Cognitive Assessment.