中药敷脐相关联合疗法辅助治疗肝硬化腹水的网状Meta分析

Network Meta-Analysis of Chinese Medicine Umbilical Associated Therapy in the Adjunctive Treatment of Cirrhotic Ascites

目的:采用网状Meta分析方法评价中药敷脐相关联合疗法辅助治疗肝硬化腹水的临床有效性。方法:在中文数据库(知网、万方、维普数据库)和英文数据库(EMBASE、PubMed、Medline、Cochrane Library)检索治疗肝硬化腹水相关疗法,并进行随机对照研究,采用ADDIS1.16.6软件对提取数据进行荟萃分析。结果:最终纳入35篇文献,共计2919例样本,涉及10种干预措施进行分析。网状Meta分析结果显示:除中药敷脐+口服中药+艾灸+常规、中药敷脐+针灸+常规与西医常规疗法差异无统计学差异外,其余各种中药敷脐联合疗法在提高肝硬化腹水临床治疗有效率方面均优于西医常规治疗,但各种联合疗法之间的两两比较差异均无统计学差异。干预总有效率从优到劣排序中,中药敷脐+口服中药+针灸+常规排列第一,因此有可能成为最佳的治疗方案。结论:受纳入文献数量和质量限制,本研究结果仍需更多高质量的多中心、大样本的随机对照试验加以证实。

To evaluate the clinical efficacy of different traditional Chinese medicine umbilical associated therapy in the adjunctive treatment of cirrhosis ascites by network meta-analysis. Methods: Chinese databases(CNKI, Wanfang and Wipp databases) and English databases(EMBASE, PubMed, Medline and Cochrane Library) were searched by computer. Relevant treatment methods for cirrhotic ascites were searched, and randomized controlled studies were conducted. The data were extracted according to the pre-prepared table, and the data were analyzed by ADDIS1.16.6 software. Results: Eventually, 35 literatures were included, with a total of 2919 samples, involving 10 interventions for analysis. Network meta-analysis showed that except TCM umbilical therapy + oral Chinese medicine+compound moxibustion + routine treatment, TCM umbilical therapy+acupuncture+routine treatment there was no statistical difference when compare with Conventional western medicine therapy, the other TCM umbilical therapy in improving the clinical treatment efficiency of cirrhosis ascites are superior to western medicine conventional treatment. However, there was no statistically significant difference in pairwise comparison between various combination therapies. Based on the rank of overall intervention efficiency, we find that the TCM umbilical therapy + oral Chinese medicine compound+acupuncture+routine treatment held the top rank, which is likely to be a the best treatment. Conclusion: However, due to limitation of the number and quality of included literatures, the conclusion of this study still needs to be confirmed by more high-quality multicenter and large-sample randomized controlled trials.