乌梅方加减联用西药治疗溃疡性结肠炎的系统评价和Meta分析

Meta-analysis on Wumei Decoction Combined with Western Medicines in Treating Ulcerative Colitis

目的:探讨乌梅方加减治疗溃疡性结肠炎的有效性和安全性,为临床推广提供科学依据。方法:纳入乌梅方加减联用西药与单用西药治疗溃疡性结肠炎的随机对照试验文献(randomized controlled trials,RCTs),用Cochrane评价方法对文章的质量进行评分;收集纳入文章的治疗方法、样本量、临床疗效、肠镜炎症改善疗效和不良反应,对疗效和不良反应进行Meta分析。结果:共纳入11篇RCTs文献,Meta分析结果示:对比单用西药,乌梅方加减联用西药临床疗效、肠镜炎症改善疗效的合并RR值分别为1.57,95%CI(1.42,1.75)和2.26,95%CI(1.38,3.71),差别均有统计学意义(P<0.05)。2种治疗方法的不良反应没有统计学意义。敏感性分析和漏斗图分析显示纳入的文献同质性较强,不存在发表偏倚。结论:对比单用西药,乌梅方加减联用西药治疗溃疡性结肠炎有更好的临床疗效和肠镜炎症改善疗效,且安全性良好,适合临床的推广使用。但由于纳入文献的质量不高,在试验设计存在严重不足,需要高质量的大样本双盲随机对照试验的支持。

Objective： To discuss the effectiveness and safety of Wumei decoction in the treatment of ulcerative colitis. Method： Randomized controlled trials（ RCTs） about Wumei decoction combined with western medicines and western medicine in treating ulcerative colitis were included. Their qualities were assessed by the Cochrane scale. The therapies,sample size,clinical efficacy,endoscopic improvement and adverse events of the included literatures were collected. A Meta-analysis was made on the efficacy and adverse events. Result： A total of 11 RCTs were included. The results of Meta-analysis showed that compared with the western medicine group,the combined RR of clinical efficacy and endoscopic improvement in the Wumei combined group was 1. 57,95% CI（ 1. 42,1. 75） and 2. 26,95% CI（ 1. 38,3. 71）,with statistical significance（ P 〈 0. 05）. Both of their adverse events showed no significant difference. The sensitivity analysis and funnel plot analysis showed a higher homogeneity in the literatures and no evidence of publication bias. Conclusion： Compared with the western medicine,Wumei combined with western medicines had a better clinical efficacy and endoscopic improvement and good safety and so is suitable for clinical use. However,due to the low quality of the included literatures and insufficient experimental design,the study needs the support from a large sample-size randomized double-blind controlled trial.