中药治疗胃食管反流病的系统评价/Meta分析的再评价

Chinese Herbal Medicine for Treatment of Gastroesophageal Reflux Disease:An Overview of Systematic Reviews and Meta-analyses

目的:对中药治疗胃食管反流病(GERD)的系统评价/Meta分析进行再评价研究。方法:计算机检索Pub Med、Cochrane Library、EMbase、CBM、CNKI、VIP和Wan Fang数据库,查找中药治疗胃食管反流病的系统评价/Meta分析,检索时限均为自建库至2018年6月1日,由2位研究者独立阅读文题和摘要,根据纳入和排除标准,选取符合要求的文献并阅读全文。采用AMSTAR量表和GRADE方法对纳入的研究分别进行方法学质量评价和证据质量等级评价。结果:共纳入20个系统评价/Meta分析,AMSTAR评分在2~8分之间,均为低、中等质量。GRADE评价结果显示证据质量等级为极低级、低级和中级,无高级证据。主要结果显示,中药相对目前的西药治疗有一定优势,但在复发率、不良反应方面,由于缺乏大量高证据质量的研究,尚不能形成统一定论。结论:目前针对中药治疗胃食管反流病的系统评价/Meta分析的方法学质量不高,证据质量等级较低,故应严格按照循证医学设计的要求运用于将来的临床试验和系统评价中,从而为临床决策者提供更高质量的证据。

Objective:To evaluate the relevant systematic reviews/Meta-analyses that focused on the Chinese herbal medicine for treatment of gastroesophageal reflux disease(GERD).Methods:Databases including Pub Med,Cochrane Library,EMbase,CBM,CNKI,VIP and Wan Fang were searched from inception to June 1,2018 to collect the systematic reviews/Meta-analyses that focused on the Chinese herbal medicine for GERD.Two researchers independently read the title and abstract,selected the documents according to the inclusion and exclusion criteria and read the full text.The AMSTAR scale and the GRADE method were used to evaluate the methodological quality and evaluate the quality of evidence for the included studies.Results:A total of 20 systematic reviews/Meta-analyses were included.AMSTAR scores ranged from 2 to 8 points,both low and medium quality.GRADE evaluation results showed that the quality of evidence was very low,low and intermediate,and there was no high-level evidence.The main results showed that Chinese herbal medicine had certain advantages over the current Western medicine treatment.But in terms of relapse rate and adverse reactions,due to lack of a large number of high-quality research,it was still unable to form a unified conclusion.Conclusion:At present,the systematic evaluation/Meta-analysis of Chinese herbal medicine for the treatment of gastroesophageal reflux disease has a low methodological quality and a low level of evidence quality,so it should be applied to future clinical trials and systematic reviews strictly in accordance with the requirements of evidence-based medicine design.This provides higher quality evidence for clinical decision makers.