养胃颗粒治疗慢性胃炎有效性和安全性的系统评价与Meta分析

Systematic review and Meta-analysis of efficacy and safety of Yangwei Granules for chronic gastritis

系统评价养胃颗粒联合常规西药治疗慢性胃炎的有效性与安全性。计算机检索CNKI、SinoMed、万方、VIP、PubMed、Cochrane Library和EMbase数据库,收集关于养胃颗粒联合常规西药治疗慢性胃炎的随机对照试验(RCT)。由2名评价员根据纳入与排除标准筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3软件进行Meta分析。共纳入12个RCTs,1 164例患者。Meta分析结果显示,(1)临床总有效率:养胃颗粒联合常规西药组对慢性胃炎的临床总有效率优于常规西药组,差异有统计学意义(RR=1.24,95%CI[1.17,1.31],P<0.000 01);(2)Hp根除率:与常规西药组相比,养胃颗粒联合常规西药组有利于提高慢性胃炎患者中Hp的根除率,差异有统计学意义(RR=1.24,95%CI[1.15,1.34],P<0.000 01);(3)不良反应发生率:养胃颗粒联合常规西药组的不良反应发生率低于对照组,但差异无统计学意义(RR=0.83, 95%CI[0.39, 1.79],P=0.64);(4)胃肠激素和血管活性肽水平:与常规西药组相比,养胃颗粒联合常规西药组有利于降低慢性萎缩性胃炎患者胃动素(MD=-17.31,95%CI[-21.83,-12.79],P<0.000 01)和内皮素水平(MD=-6.60,95%CI[-10.07,-3.13],P=0.000 2),而升高胃泌素(SMD=0.94,95%CI[0.50,1.38],P=0.003)和降钙素基因相关肽水平(MD=5.82,95%CI[4.25,7.39],P<0.000 01),差异均有统计学意义;(5)胃蛋白酶原:与常规西药组相比,养胃颗粒联合常规西药组可升高PGⅠ水平(MD=6.40,95%CI[4.26,8.54],P<0.000 01)及PGR(MD=0.89,95%CI[0.71,1.07],P<0.000 01),而降低PGⅡ水平(MD=-1.24,95%CI[-2.15,-0.33],P=0.007),差异均有统计学意义。当前证据显示,养胃颗粒联合常规西药治疗慢性胃炎的临床疗效和Hp根除率均优于单纯常规西药组,并能有效改善慢性萎缩性胃炎患者胃肠激素、血管活性肽和胃蛋白酶原水平,不增加不良反应的发生。受纳入研究的质量和数量的影响,上述结论有待开展大样本、高质量的RCT予以证实。

To systematically evaluate the efficacy and safety of Yangwei Granules combined with conventional Western medicine for chronic gastritis. CNKI, SinoMed, WanFang, VIP, PubMed, Cochrane Library and EMbase database were electronically retrieved to collect randomized controlled trial(RCT) of Yangwei Granules combined with conventional Western medicine for chronic gastritis. Two reviewers independently screened out literatures according to the inclusion and exclusion criteria and extracted data, and evaluated the risk of bias of included studies. Meta-analysis was conducted by using RevMan 5.3 software. A total of 12 RCTs involving 1 164 patients were included. The results of Meta-analysis showed that:(1) The total effective rate of Yangwei Granules combined with conventional Western medicine for chronic gastritis was better than that of conventional Western medicine group, with a statistically significant difference(RR=1.24,95%CI[1.17,1.31],P<0.000 01).(2) Compared with the conventional Western medicine group, the Yangwei Granules combined with conventional Western medicine group was conducive to improving the Hp eradication rate, with a statistically significant difference(RR=1.24,95%CI[1.15,1.34],P<0.000 01).(3) The incidence of adverse reactions in Yangwei Granules combined with conventional Western medicine group was lower than that in the control group, but with no statistically significant diffe-rence(RR=0.83, 95%CI[0.39, 1.79], P=0.64).(4) Compared with the conventional Western medicine group, the Yangwei Granules combined with conventional Western medicine group was beneficial to the reduction of motilin level(MD=-17.31,95%CI[-21.83,-12.79],P<0.000 01) and endothelin level(MD=-6.60,95%CI[-10.07,-3.13],P=0.000 2), while the increase of gastrin level(SMD=0.94,95%CI[0.50,1.38],P=0.003) was related to calcitonin gene the level of peptide(MD=5.82,95%CI[4.25,7.39],P<0.000 01), with statistically significant differences.(5) Compared with conventional Western medicine group, Yangwei Granules combined with conventional Western medicine group could increase PGⅠ(MD=6.40,95%CI[4.26,8.54],P<0.000 01) and PGR(MD=0.89,95%CI[0.71,1.07],P<0.000 01), while decrease PGⅡ(MD=-1.24,95%CI[-2.15,-0.33],P=0.007), with statistically significant differences. Current evidence showed that the clinical efficacy and Hp eradication rate of Yangwei Granules combined with conventional Western medicine in the treatment of chronic gastritis were better than those of the conventional Western medicine group alone, and could effectively improve the level of gastrointestinal hormones, vasoactive peptide and the pepsinogen level in patients with chronic atrophic gastritis, without increasing the incidence of adverse reactions. However, due to the limited quality and quantity of included studies, the above conclusions need to be confirmed by more large-scale and high-quality RCTs.