附子理中汤为主方治疗腹泻型肠易激综合征的Meta分析

The clinical efficacy of Fuzi Lizhong decoction as main prescription in the treatment of diarrhea irritable bowel syndrome:a Meta analysis

[目的]评价附子理中汤加减治疗腹泻型肠易激综合征(IBS-D)的临床效果。[方法]通过互联网检索知网、维普、万方、PubMed、the Cochrane library数据库中附子理中汤为主方治疗IBS-D的随机对照实验,检索时间限定为建库至2020年2月。筛选文献、归纳数据资料,对纳入的研究数据进行分析和质量评估,利用RevMan 5.3软件对观察指标进行Meta分析。[结果]共纳入9篇临床研究,包含925例患者。Meta分析结果显示:附子理中汤加减治疗IBS-D的有效率与西医常规治疗相比,在总有效率(OR=4.81,95%CI 3.20~7.25,P<0.00001),症状积分(SMD=-0.29,95%CI-3.27^-0.91,P=0.0005),生活质量(SMD=1.44,95%CI 0.50~2.38,P=0.003),复发率(OR=0.29,95%CI 0.13~0.63,P=0.002)等方面,疗效均更显著。漏斗图分析不对称,表明可能存在发表性偏倚。[结论]附子理中汤加减治疗IBS-D优于常规西药治疗,但研究的质量较低,尚需更多设计严谨的多中心随机对照实验以增加证据强度。

[Objective]To systematically evaluate the efficacy of Fuzi Lizhong decoction as main prescription in the treatment of diarrhea irritable bowel syndrome(IBS-D).[Methods]The randomized controlled trials(RCT)of Fuzi Lizhong decoction on IBS-D were searched through CNKI,Wanfang,VIP,PubMed,the Cochrane library database from inception to February,2020.Meanwhile,after screening the literature,extracting the data and making the inclusion data extraction and quality assessment,the RevMan 5.3 software was used for Meta analysis.[Results]A total of 9 RCT was enrolled,including 925 patients.Meta analysis showed that Fuzi Lizhong decoction as the main prescription has a certain advantage in the total effective rate[OR=4.81,95%CI 3.20-7.25,P<0.00001],symptom score[SMD=-0.29,95%CI-3.27--0.91,P=0.0005],quality of life[SMD=1.44,95%CI 0.50-2.38,P=0.003],recurrence rate[OR=0.29,95%CI 0.13-0.63,P=0.002].Funnel-plot was asymmetrical,which indicate the possible existence of publication bias.[Conclusion]Fuzi Lizhong decoction as the main prescription has a certain advantage over conventional western medicine.However,the quality of the study is low and more well-designed multicenter randomized controlled trials are needed to increase the strength of the evidence.