膈下逐瘀汤加减联合核苷类药物治疗乙型肝炎肝硬化疗效及安全性的Meta分析

Meta Analysis of Curative Effect and Safety of Gexia Zhuyu Decoction Combined with Nucleoside Drugs in the Treatment of Hepatitis B Cirrhosis

目的:评价膈下逐瘀汤加减联合核苷类药物治疗乙型肝炎肝硬化的疗效以及安全性。方法:检索中国知网数据库(CNKI)、重庆维普中文科技期刊数据库(VIP)和万方数字化期刊全文数据库、The Cochrane Library、Pubmed数据库,纳入随机对照试验(randomized controlled trials,RCTs)相关临床试验数据。检索时限为自建库开始至2018年3月10日。分析由2名独立研究者独立选择试验和质量评价后,提取数据并分析。结果:共纳入13个研究,纳入研究对象1151例,其中试验组579例,对照组572例。结果显示:膈下逐瘀汤联合核苷类药物可降低总胆红素指标TBIL[MD=-10.85(95%可信区间(confidence interval,CI)95%CI:-14.67,-7.03),P<0.000 01]、有效改善肝功能ALT[MD=-29.19(95%CI:-37.50,-20.87),P<0.000 01]、AST[MD=-28.72(95%CI:-40.47,-16.97),P<0.000 01],降低肝纤维化指标透明质酸(HA)水平[MD=-57.39(95%CI:-80.80,-33.99),P<0.000 01]、层粘连蛋白(LN)水平[MD=-17.18(95%CI:-19.93,-14.43),P<0.000 01]、Ⅳ型胶原蛋白(Ⅳ-C)水平[MD=-16.73(95%CI:-18.81,-14.66),P<0.000 01]、Ⅲ型前胶原(PCⅢ)水平[MD=-22.60(95%CI:-25.26,-19.94),P<0.000 01],减少Child-Pugh分级评分[MD=-1.33(95%CI:-1.62,-1.05),P<0.000 01],且均优于单纯核苷类药物治疗(P<0.000 01)。结论:膈下逐瘀汤联合核苷酸类药物治疗乙型肝炎肝硬化的疗效优于单用核苷类药物。

Objective: To evaluate the efficacy and safely of Gexia Zhuyu decoction combined with nucleoside drugs in the treatment of hepatitis B cirrhosis. Methods: to search the database of China knowledge Network ( CNKI), Chongqing Weipu Chinese Science and Technology periodical Database (VIP) and Wanfang Digital Journals full text Database (The Cochrane Library,Pubmed), which were included in the randomized controlled trial) related clinical trial data. The time limit for retrieval is from the beginning of the library construction to March 10, 2018. The data were extracted and analyzed by two independent researchers. Results: A total of 13 subjects were included in the study, including 579 cases in the experimental group and 572 cases in the control group. The results showed that Gexia Zhuyu decoction combined with nucleoside drugs could reduce the total bilirubin index TBIL [ MD =- 10. 85 (95% confidence interval ( confidence interval ,CI) 95 CI - 14. 67), P -7. 03), P <0. 000 01]. Improve liver function effectively ALT [ MD =- 29. 19 (95 CI:-37.50 -20.87), P <0.000 01], AST [95 CI:-40. 47 - 16. 97), P < 0. 000 01 ], The level o￡ hyaluronic acid (HA)( MD =-57.39) and laminin (LN)(MD =-17. 18) were decreased [ MD =-57.39 (95 CI:- 80. 80 -33.99), P <0.000 01)] and MD =-17.18 (95 CI:-19.93%-14.43). P <0.000 01, MD =-16.73 (95 CI:-18.81 -14.66), P <0.000 01), MD =-22.60 (95 CI:-25.26), PC ID (P <0.000 01).-19.94), P< 0. 000 01, MD =- 1.33 (95 CI :- 1.62U - 1.05 ), P <0. 000 01), and all of them were superior to nucleoside drug therapy ( P < 0. 000 01 ). Conclusion : Gexiazhuyu decoction combined with nucleotides is superior to nucleoside in the treatment of hepatitis B cirrhosis.