中药复方干预抗结核化疗致肝损伤疗效的系统评价

Systematic Evaluation on the Effect of Chinese Medicine Formula on the Intervention of Liver Injury Induced by Anti-Tuberculosis Chemotherapy

目的系统评价中药复方干预抗结核化疗致肝损伤的有效性。方法计算机检索中国知网、维普期刊数据库、万方数据和Pub Med数据库,搜集中药复方干预抗结核化疗致肝损伤的随机对照试验(RCT),检索时限均为建库至2019年3月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入17个RCT,共计1 410位抗结核化疗致肝损伤患者。Meta分析结果提示:与常规保肝治疗比较,中药复方干预抗结核化疗致肝损伤的有效率[RR=1.83,95%CI(1.50,2.23),P<0.01]、血清谷丙转氨酶(ALT)[MD=-50.38,95%CI(-54.17,-46.58),P<0.01]、谷草转氨酶(AST)[MD=-61.65,95%CI(-72.68,-50.61),P<0.01]、总胆红素(TBiL)[MD=-11.02,95%CI(-13.24,-8.79),P<0.01]均优于对照组。结论中药复方更有利于减轻和控制抗结核化疗过程中肝损伤的发生,对保证结核病人规律服药,控制病情、完成抗结核治疗方案具有重要的意义。

OBJECTIVE To systematically evaluate the efficacy of Chinese medicine formula in the intervention of liver injury induced by anti-tuberculosis chemotherapy.METHODS CNKI,VIP,Wanfang Data and Pub Med databases were searched to collect randomized controlled trial(RCT)of Chinese medicine formula in intervention of liver injury induced by anti-tuberculosis chemotherapy from inception to the first of March 1,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was then performed by RevMan 5.3 software.RESULTS A total of 17 RCTs involving 1 410 patients with liver injury caused by anti-tuberculosis chemotherapy were included.The results showed that compared to the conventional treatment to protecting liver,intervention with Chinese medicine formula could significantly improve the effective rate [RR=1.83,95%CI(1.50,2.23),P<0.01],and its serum glutamic pyruvic transaminase(ALT)[MD=-50.38,95%CI(-54.17,-46.58),P<0.01],glutamic oxalacetic transaminase(AST)[MD=-61.65,95%CI(-72.68,-50.61),P<0.01],and total bilirubin(TBiL)[MD=-11.02,95%CI(-13.24,-8.79),P<0.01]were all better.CONCLUSION Current evidence shows that Chinese medicine formula is more conducive to reduce and control the occurrence of liver injury in the course of anti-tuberculosis treatment.It is of great significance to ensure that tuberculosis patients take drugs regularly,control their condition and complete the anti-tuberculosis treatment program.