中药保留灌肠治疗放射性直肠炎疗效的Meta分析

A Meta-analysis on the curative effects of Chinese herbal retention enema on radiation enteritis

目的应用Meta分析方法评价中药保留灌肠治疗放射性直肠炎的疗效。方法计算机检索The Cochrane Library、Pub Med、EMbase、EBSCO、ISI、CNKI、VIP、Wan Fang Data和CBM数据库中关于中药保留灌肠治疗放射性直肠炎的随机对照试验,并追溯纳入文献的参考文献,检索时限均从建库至2014年5月。由2名研究者按照纳入排除标准独立进行文献筛选、资料提取、质量评价并交叉核对后,采用Rev Man5.3软件进行Meta分析。结果纳入25个随机对照试验,其中进行Meta分析的有21个共1 575例患者。Meta分析显示,干预14 d后[RR=1.25,95%CI(1.10,1.42),P=0.000 6]、20 d后[RR=1.19,95%CI(1.08,1.32),P=0.000 7]、28 d后[RR=1.37,95%CI(1.21,1.54),P<0.000 01]、30 d后[RR=1.63,95%CI(1.32,2.01),P<0.000 01]中药保留灌肠治疗放射性直肠炎的总有效率高于对照组;干预10 d后[RR=1.23,95%CI=(0.93,1.63),P=0.15]、60 d后[RR=1.22,95%CI(0.94,1.56),P=0.13]中药保留灌肠治疗放射性直肠炎的总有效率与对照组相比差异无统计学意义。结论对放射性直肠炎患者实施中药保留灌肠干预2周以上能提高治疗的总有效率,减轻临床症状。但仍需要大样本、高质量的临床试验做进一步研究,观察长期效果。

Objective It is to evaluate the effect of Chinese herbal retention enema on radiation enteritis using Meta-analy- sis method. Methods The Cochrane Library, PubMed, EMbase, EBSCO, ISI, CNKI, VIP, WanFang Data and CBM data- bases were searched to collect the randomized controlled trials （RCTs） from the inception to May, 2014 about Chinese herbal retention enema on radiation enteritis, and the references of the included literature were also retrieved. Two reviewers inde- pendently screened the literatures according to the inclusion and exclusion criteria, extracted the data, and evaluated and cross-checked the methodological quality. Then Meta-analysis was conducted with RevMan 5.3 software. Results A total of 25 RCTs were included, only 21 RCTs involving 1 575 patients were used for Meta-analysis. The subgroup analyses based on the length of intervention time showed that, after 14-day [RR=1.25, 95%CI（1.10,1.42）, P=0.0006], 20-day [RR= 1. 19, 95%CI（1.08,1.32）, P =0.0007], 28-day [RR =1.37, 95%CI（1.21, 1.54）, P 〈0.00001] and 30-day [ RR = 1.63, 95% CI（ 1.32, 2.01 ）, P 〈0. 000 01 ] intervention, the overall effective rate of the Chinese herbal retention enema group was higher than that of the control group, with a significant difference. After 10 days [ RR = 1.23, 95% CI（0.93, 1.63 ）, P = 0.15 ] and 60 clays [ RR = 1.22, 95% CI（0.94, 1.56） , P = 0.13 ] intervention, the overall effective rate of the Chinese herbal retention enema group had no significant difference compared with control group. Conclusion Chinese herbal retention enema can improve the overall effective rate for radiation enteritis and relieve the clinical symptoms within certain intervention time; there is an urgent need for large sample, well-planned and long-term clinical studies to address the effectiveness of Chinese herbal retention enema for treating radiation enteritis.