一贯煎加减联合西医常规方案治疗肝硬化腹水疗效和安全性的系统评价

Systematic Review on Efficiency and Safety of Yiguanjian Decoction Combined with Conventional Western Medicine in the Treatment of Ascites Induced by Liver Cirrhosis

目的:系统评价一贯煎加减联合西医常规方案治疗肝硬化腹水的疗效和安全性。方法:全面检索中国知网、维普数据库、万方数据库、Embase、Web of science、PubMed和Clinical Trials数据库,纳入符合标准的随机对照试验(对照组采用肝硬化腹水的西医常规治疗;观察组在对照组基础上加用一贯煎加减),检索时间均为建库至2023年2月。采用Cochrane协作网偏倚风险评价工具进行质量评价,并使用RevMan 5.4软件对提取的数据进行Meta分析。结果:最终纳入15篇文献,共1147例患者。Meta分析结果显示,与对照组比较,观察组治疗方案可提高总有效率(RR=1.31,95%CI=1.24~1.40,P<0.00001),缩小腹围(MD=-8.26,95%CI=-10.44~-6.09,P<0.00001),减轻体质量(MD=-6.86,95%CI=-8.23~-5.48,P<0.00001),增加24 h尿量(MD=465.38,95%CI=351.27~579.48,P<0.00001),缩短腹水消退时间(MD=-7.29,95%CI=-13.97~-0.61,P=0.03),并促进肝功能改善;同时,观察组患者的各项不良反应发生率均降低。结论:联合一贯煎加减治疗能提高西医常规方案对肝硬化腹水的疗效,且不良反应较少。

OBJECTIVE:To systematically evaluate the efficacy and safety of Yiguanjian decoction combined with conventional western medicine in the treatment of ascites induced by liver cirrhosis.METHODS:CNKI,VIP,Wanfang Data,Embase,Web of science,PubMed and Clinical Trials databases were retrieved to collect randomized controlled trials that met the screening criteria(the control group received conventional western medicine,while the observation group received Yiguanjian decoction on the basis of control group),the search time was from the establishment of the database until Feb.2023.The Cochrane Collaboration Network bias risk assessment was used for quality assessment,and Meta-analysis was performed by using RevMan 5.4 software.RESULTS:Totally 15 articles were enrolled,including 1147 patients.Meta-analysis showed that compared with the control group,the treatment regimen in the observation group could improve the total effective rate(RR=1.31,95%CI=1.24-1.40,P<0.00001)and reduce abdominal circumference(MD=-8.26,95%CI=-10.44--6.09,P<0.00001),decrease body mass(MD=-6.86,95%CI=-8.23--5.48,P<0.00001),increase 24 h urine volume(MD=465.38,95%CI=351.27-579.48,P<0.00001),and shorten disappearance time of ascites(MD=-7.29,95%CI=-13.97--0.61,P=0.03),and improve liver function.Meanwhile,the incidence of adverse drug reactions in the observation group decreased.CONCLUSIONS:Yiguanjian decoction can improve the efficacy of conventional western medicine treatment of cirrhotic ascites,with few adverse drug reactions.