中药保留灌肠联合西医常规药物治疗肝性脑病的系统评价

Systematic Review on Retention Enema of Traditional Chinese Medicine Combined with Conventional Therapy of Western Medicine in Treatment of Hepatic Encephalopathy

目的:系统评价中药保留灌肠联合西医常规药物治疗肝性脑病的疗效。方法:计算机检索the Cochrane Library、PubMed、EMBase、Medline、中国知网医学数据库、维普全文数据库、万方数据库和中国生物医学文献数据库,搜集在西医常规药物治疗基础上加用中药保留灌肠(观察组)对比西医常规药物(对照组)治疗肝性脑病的随机对照试验,检索时限均为建库至2019年6月。筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 15.0软件进行荟萃分析(Meta分析)。结果:最终纳入44篇文献,共3294例患者。Meta分析结果显示:与单纯使用西医常规药物治疗比较,中药保留灌肠联合西医常规药物治疗肝性脑病可显著提高患者的总有效率(OR=3.86,95%CI=3.19~4.66,P=1.000),显著降低血氨水平(OR=-2.57,95%CI=-3.10^-2.04,P=0.000),提高丙氨酸氨基转移酶复常疗效(OR=-1.08,95%CI=-1.45^-0.71,P=0.000)和总胆红素复常疗效(OR=-0.99,95%CI=-1.37^-0.61,P=0.000),差异均有统计学意义。结论:中药保留灌肠联合西医常规药物治疗肝性脑病有显著疗效。

OBJECTIVE:To systematically evaluate the efficacy of retention enema of traditional Chinese medicine(TCM)combined with conventional therapy of western medicine in treatment of hepatic encephalopathy.METHODS:Randomized controlled trials from base-building to Jun.2019 on conventional therapy of western medicine combined with retention enema of TCM(the observation group)in contrast with conventional western medicine alone(the control group)were retrieved from the Cochrane Library,PubMed,EMBase,Medline,CNKI,VIP,Wanfang and CBM.After literature screening,data extraction and evaluate of bias risk,Stata 15.0 was adopted to conduct Meta analysis.RESULTS:A total of 44 studies were involved,including 3294 patients.Results of Meta analysis indicated that compared with using conventional western medicine alone,the combination of conventional therapy of western medicine and retention enema of TCM in treatment of hepatic encephalopathy can significantly promote the total effective rate(OR=3.86,95%CI=3.19-4.66,P=1.000),reduce blood ammonia level(OR=-2.57,95%CI=-3.10--2.04,P=0.000),improve the efficacy of alanine aminotransferase(ALT)recovery(OR=-1.08,95%CI=-1.45--0.71,P=0.000)and total bilirubin(TBIL)recovery(OR=-0.99,95%CI=-1.37--0.61,P=0.000),with statistically significant differences.CONCLUSIONS:Retention enema of TCM combined with conventional therapy of western medicine has significant efficacy in treatment of hepatic encephalopathy.