半夏泻心汤加减方治疗慢性萎缩性胃炎临床疗效的系统评价

Meta-analysis of clinical effect of Banxia Xiexin decoction on patients with chronic atrophic gastritis

目的评价以半夏泻心汤为主方加减治疗慢性萎缩性胃炎的临床疗效。方法通过制定随机对照检索策略和对国内主要数据库检索(不考虑盲法),2名评价人员分别根据纳入标准和剔除排除标准对检索的随机对照试验进行3次独立筛选和对所纳入研究进行有效的数据提取,并分别对文献质量进行科学评价,最终经核对一致的数据进行统计合并,根据异质性分析选用固定效应模式或随机效应模式进行系统分析。结果共9篇594例随机对照实验纳入研究,半夏泻心汤加减方的临床疗效总有效率,RR=1.24,95%CI(1.07,1.45),P=0.004;临床疗效愈显率,RR=1.67,95%CI(1.13,2.49),P=0.01。同时胃镜疗效总有效率,RR=1.42,95%CI(1.12,1.79),P=0.004;胃镜疗效愈显率,RR=1.96,95%CI(1.34,2.86),P=0.000 6。其中3项研究数据纳入根除幽门螺旋杆菌根除情况RR=1.05,95%CI(0.74,1.49),P=0.79;肠上皮化生改善情况[RR=1.23,95%CI(0.96,1.58),P=0.10。结论 Meta分析显示半夏泻心汤加减方在临床和胃镜疗效上优于对照组,而幽门螺杆菌根除状况和肠上皮化生改善上尚不能认为优于对照组;由于所纳入研究较少且部分研究为偏倚风险不确定的随机对照研究,需高质量和低偏倚风险的研究进一步证实。

Objective To evaluate the effect of chronic atrophic gastritis （CAG） treated with Banxia Xiexin decoction （BXD）. Methods After searching randomized clinical trials （RCT） of treating CAG with Banxia Xiexin decoction with adopting strategy for literature search in CBM, CNKI and Wanfang database （excluding blinding）, two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials three times to identify studies for inclusion based on exclusive and inclusive criterion. Analytic studies which had reported relative risk （RR） , 95% confidence interval（CI）, or required data to calculate them were included. Fixed effects model or random effects model was applied by heterogeneity between the studies. Results Nine RCTs with 594 cases were included. There was statistically significant between two groups（ BXD group and control group） on clinical efficacy rate [ RR = 1.24,95 % CI （ 1.07,1.45 ） , P = 0.004 ] , clinical curative rate [ RR = 1.67, 95 % CI （ 1.13,2.49 ）, P = 0.01 ] , gastroscopy efficacy rate [ RR = 1.42,95% CI ： （ 1.12,1.79）, P = 0. 004 ] and gastroscopy curative rate [ RR = 1.96,95 % CI ： （ 1.34,2.86 ）, P = 0. 000 6 ]. There was no significant difference between two groups in Helicobacter Pylori eradication [ RR = 1.05,95 % CI ： （0.74,1.49）, P = 0.79 ] or intestinal metaplasia improvement [ RR = 1.23,95% CI ： （0.96,1.58）, P = 0. 10 ]. Conclusion Banxia Xiexin decoction had a significant effect on clinical and gastroscopy compared with control group. While further randomized trials with high-quality and low-risked bias are required.