结肠透析(灌洗)联合中药灌肠治疗重型肝炎效果的meta分析

Effect of Colon Dialysis( Irrigation) Combined Traditional Chinese Medicine Enema in Treatment of Heavy-duty Hepatitis: A Meta-analysis

目的:评价结肠透析(灌洗)联合中药灌肠治疗重型肝炎的疗效和安全性。方法:计算机检索CBM、VIP、CNKI及Cochrane图书馆临床对照试验数据库等,查找符合纳入标准的随机对照试验,文献检索时间均从建库截至2012年12月。并按Cochrane系统评价手册的文献质量评价办法评价纳入研究的方法学质量,而后提取相关数据用Rev Man 5.0软件进行Meta分析。结果:最终纳入9篇随机对照试验,共969例。结果显示:与西医综合治疗相比,结肠透析(灌洗)联合中药灌肠治疗重型肝炎对降低肝功能ALT的效果优于常规治疗[MD(95%CI)为-16.41(-22.45,-10.37),P<0.00001];血氨情况也有显著效果[MD(95%CI)为-24.95(–47.65,-2.25),P=0.03];凝血功能PT的改善与对照组相比也有显著效果[MD(95%CI)为-4.11(–6.81,-1.40),P=0.003]。结论:现有证据证明结肠透析(灌洗)联合中药灌肠治疗重型肝炎有一定疗效且相对安全,由于纳入分析的研究质量差异较大,因此有必要进行大样本、多中心、随机、双盲的对照试验,以进一步证实其临床疗效。

Objective： To evaluate the efficacy and safety of colon dialysis （irrigation）combined traditional Chinese medicine enema treatment on heavy -duty hepatitis. Methods：The following electronic databases as CBM, VIP, CNKI and the Cochrane Library and so on were retrieved on computer from their establishment to December 2012 to search the randomized controlled trials （RCTs） which met the inclusion criteria of randomized controlled trials. The methodological quality of in- cluded studies was assessed and the data was extracted and analyzed by using the Cochrane Collaboration ＇s Rev Man 5.0 software. Results ： A total of 9 RCTs involving 969 participants were included. The Meta - analysis showed that compared with the conventional comprehensive treatment method,the new way tended to be superior in reducing the effect of hepatic function,the ALT [ MD （95% CI） was -41.13 （ - 112.67,30.41 ） ,P 〈0.00001 ] ;the same result in blood ammonia [ MD （95% CI） was -24.95 （ -47.65, -2.25 ）, P = 0.03 ]. Compared with the control group, the blood clotting PT and PTA improvement also had significant effect [ MD （95 % CI） was - 4.11 （ - 6.81, - 1.40 ）, P = 0.003 ; 16.02 （ 12.44,19.59 ）, P 〈 0. 00001 ]. Conclusion： On the basis of available evidence, the colon dialysis （irrigation） combined traditional Chinese medicine enema treatment for heavy -duty hepatitis is effective and safe. However,there were some differences among en- rolled quality of studies. It needs to design more large sample, muhicenter, strictly randomized and double - blind controlled trials to validate these conclusions and to further confirm the clinical curative effect.