中药保留灌肠治疗溃疡性结肠炎疗效的系统评价

Effects of Retention Enema with Traditional Chinese Medicines in the Treatment of Ulcerative Colitis:A Systematic Appraisal

目的 评价中药保留灌肠治疗溃疡性结肠炎的疗效.方法 应用国际Cochrane协作网系统评价方法,对中药保留灌肠治疗溃疡性结肠炎的随机对照试验(RCT)进行系统评价.计算机检索(1995～2005年)EMBASE、中国生物医学文献数据库、中国期刊网等.手工检索发表与未发表的文献,纳入中药与传统西药治疗措施相比较的随机对照试验,统计学处理采用Cochrane协作网的Rev Man 4.2软件.结果 共纳入23个RCT试验.短期结果显示中药灌肠组比对照组的疗效好,8个RCT结果显示中药灌肠组有效率(92.8%)高于口服柳氮磺吡啶组(89.9%),3个RCT结果显示中药灌肠组有效率(93.1%)高于庆大霉素加皮质激素灌肠组(71.6%),4个RCT结果显示中药灌肠组有效率(94.2%)高于柳氮磺吡啶加皮质激素组(74.9%).中药灌肠治疗未发现明显不良反应.结论 该研究所纳入试验的方法学质量均较低,虽显示中药灌肠疗法在改善溃疡性结肠炎近期临床疗效指标方面优于常规西药疗法,但因无评价远期疗效的试验,尚不能对其疗效得出可靠的结论.

Objective To assess the therapeutic effectiveness of retention enema with traditional Chinese medicines in the treatment of ulcerative colitis. Methods According to the method provided by the international Cochrane Coordination Net,the randomized controlled trials(RCTs) concerning the retention enema treatment of ulcerative colitis with the traditional Chinese medicines were subjected to a systematic appraisal.An electronic search of the Excerpta Medica Database(EMBASE),Chinese Biomedical Database(CBMdisc) and Chinese National Knowledge Infrastruc of ture(CNKI)(1995-2005),as well as a manual search of published and unpublished literatures was carried out for the inclusion of the data into RCTs for the comporison between traditional Chinese medicines and routine Western medicines in the treatment of the disease.The Rev Man 4.2 software of the Cochrane Coordination Net was used for Statistical analysis. Results A total of 23 RCTs were included in the study.The results of short-term effects showed that enema with traditional Chinese medicine was by and large superior to Western medicine.Meta-analysis of 8 RCTs indicated that the clinical effective rate of enema with traditional Chinese medicine was 92.8%(337/363),while that of oral sulfasalazine(SASP) was 89.9%(222/247).Meta-analysis of 3 RCTs revealed that the effective rate of enema with traditional Chinese medicines was 93.1%(122/131),and that of enema with glucocorticoid +gentamicin was 71.6%(68/95).Meta-analysis of 4 RCTs showed that the effective rate of enema with traditional Chinese medicines was 94.2%(260/276),while that of oral sulfasalazine+glucocorticoid was 74.9%(125/167).No major adverse reactions were encountered in patients treated with enema with traditional Chinese medicines. Conclusion The methods adopted in the present study were of relatively low quality.Although retention enema with traditional Chinese medicines was shown to be superior to routine treatment with Western medicines in the case of short-term effect,no definite conclusion,however,could be drawn from the results of the present study owing to the lack of methods for the assessments of long-term effects.