半夏泻心汤治疗慢性萎缩性胃炎随机对照试验Meta分析

Meta-analysis of Banxia Xiexin Decoction in Treatment of Chronic Atrophic Gastritis

目的系统分析半夏泻心汤治疗慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)的临床疗效和安全性。方法通过计算机检索建库时间至2019年10月中国知网数据库(CNKI)、万方数据库(Wanfang Data)、重庆维普中文科技期刊数据库(VIP)、中国生物医学文献服务系统(CBM)、PubMed五大数据库关于半夏泻心汤治疗CAG的文献863篇,并由2名评价员严格按照纳入和排除标准进行文献筛查,选择符合要求的随机对照试验,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果共纳入38篇随机对照临床研究的文献,计3261例患者,经Meta分析结果显示,与对照组相比,半夏泻心汤治疗CAG的临床总有效率、胃镜检查的改善情况、幽门螺杆菌(Helicobactor pylori,HP)转阴率、症状积分(包括上腹疼痛、胃满烦闷、食欲不振、嘈杂、口干口苦)方面效果良好,在改善呃逆嗳气症状积分、病检疗效及免疫指标方面无明显优势;半夏泻心汤联合西医常规治疗CAG在临床总有效率、HP转阴率、部分症状积分(上腹疼痛、胃满烦闷、反酸、呃逆嗳气、烧心)方面优于西医常规治疗,在改善食欲下降症状积分及胃泌素水平方面无明显优势,而关于胃镜及病检疗效、生活质量评分的研究报告较少。结论半夏泻心汤治疗CAG优于单纯西医治疗,但由于原始文献都是样本量小、偏倚风险较高的研究,胃镜及病检疗效、免疫指标、胃泌素水平、胃癌发生率、生活质量评分等结局指标尚不充分或缺乏,建议进一步开展样本量充足、设计合理、结局指标完善的临床试验进一步评价。

Objective To systematically analyze the clinical efficacy and safety of Banxia Xiexin Decoction in the treatment of chronic atrophic gastritis(CAG).Methods A total of 863 journal publications on the treatment of CAG by Banxia Xiexin Decoction were collected from the five databases of CNKI,WanFang,VIP,CBM and PubMed.The two reviewers strictly followed the inclusion and exclusion criteria to choose literatures.Cochrane RevMan 5.3 was used for the Meta-analysis.Results A total of 38 randomized controlled trials of clinical research literatures and 3261 patients were included.The Meta-analysis results showed that there was a significant difference beteewn the subgroups.Among them,compared with the control group,Banxia Xiexin Decoction had a better efficacy in total effective rate,helicobacter pylori(HP)negative rate,symptom scores,no obvious advantages in terms of sick examination curative effect and immune index.Compared with the control group,Banxia Xiexin Decoction VS Western treatments was superior in the treatment of total effective rate,negative conversion of HP infection,partial symptom scores except appetite loss and gastrin levels.Conclusion Banxia Xiexin Decoction for CAG shows curative effect.However,the efficacy of more outcome indicators such as gastroscope mucous membrane,pathological symtoms(atrophy),immune index,gastrin level,gastric cancer incidence rate and quality of life score.It is recommended to further conduct the clinical trials with sufficient sample size,reasonable design and perfect outcome indicators.