中医药治疗慢性萎缩性胃炎癌前病变疗效的系统评价

Efficacy of Chinese Herbal Medicine in Chronic Atrophic Gastritis:A Systematic Review

目的:系统评价中医药治疗慢性萎缩性胃炎癌前病变的临床疗效及安全性。方法:计算机检索CNKI(1998—2012.4)、CBM(1998—2012.4)、VIP(1998—2012.4)、万方数据库(1998—2012.4)、PubMed(1998—2012.4)、EM-base(1998—2012.4)等,纳入中药与空白、安慰剂或西药对照治疗慢性萎缩性胃炎癌前病变的随机对照临床试验,由两名研究者按照Cochrane Handbook 5.0标准独立评价文献质量、提取数据并交叉核对,使用RevMan 5.1.6软件进行Meta分析。结果:共纳入28个研究,合计2442例患者。Meta分析结果显示:与对照组相比,中医药组的总显效率(RR=1.75,95%CI:[1.56,1.97])、总有效率(RR=1.38,95%CI:[1.31,1.46])、病理学改善:萎缩(RR=2.14,95%CI:[1.65,2.78])、肠化(RR=2.50,95%CI:[1.79,3.49])、不典型增生(RR=3.89,95%CI:[2.40,6.31])、胃镜黏膜改善情况(RR=1.26,95%CI:[1.10,1.45]);中西医结合组的总显效率(RR=1.40,95%CI:[1.19,1.65])、总有效率(RR=1.28,95%CI:[1.18,1.38])差异均具有统计学意义(P<0.05)。结论:部分中药治疗慢性萎缩性胃炎癌前病变安全有效,但因尚缺乏高质量的研究,目前还不能得到较为可靠的结论。

Objective：To systematically evaluate the efficacy and safety of traditional Chinese medicine in the treatment of chronic atrophic gastritis. Methods ： We searched CNKI （ 1998 to April, 2012 ）, CBM （ 1998 to April, 2012 ）, VIP （ 1998 to April, 2012）, Wanfang Data（ 1998 to April,2012 ）, PubMed （ 1998 to April, 2012 ） and EMbase （ 1998 to April, 2012 ）. All randomized clinical trials of treating chronic atrophic gastritis with Chinese herbal medicines versus untreated, placebo or western drug groups were included. Data was extracted independently by two reviewers. The methodological quality of trials was evaluated with Co- ehrane Handbook 5：0 criteria. Meta - analyses were conducted by the RevMan 5.1.6 software. Results ： Twenty-eight trials invol- ving 2442 patients were included. The Meta - analysis results showed that ： compared with Western medicine group, Chinese medi- cine significantly improved excellent response rate, overall response rat% Pathol0gieal symptoms （atrophy, intestinal metaplasia, and dysplasia）, gastroscope mucous membrane, adverse effects and the total risk ratio（RR） were 1.75, （95 % CI ： 1.56,1.97 ） ; 1.38, （95%CI：1.31,1.46） ;2.14, （95%CI：1.65,2. 78） ;2.50, （95% CI：I. 79i3.49% ;31 89, （95% CI：2.40,6. 31） ;1.26, （95% CI：I. 10,1.45 ） ;compared with Western medicine group, combined traditional Chinese and Western medicine significantly ira-proved excellent response rate,overall response rate,adverse effects aild the total risk ratio （RR）were 1.40, （95% CI：I. 19,1. 65） ;1.28, （95% CI：I. 18,1.38） ,respectively. Conclusion： Some Chinese herbal medicines may be effective and safe in treating chronic atrophic gastritis which can not be strongly proved at present for lack of studies with high quality.