中西医结合治疗肝硬化并上消化道出血的疗效及安全性的Meta分析

Meta-analysis of integrated traditional Chinese and western medicine in treating liver cirrhosis with upper gastrointestinal bleeding

目的系统评价中西医结合治疗肝硬化并上消化道出血的疗效以及安全性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普数据库、the Cochrane Library、Pubmed、Embase公开发表的文献,纳入随机对照试验。由两位评价者独立对纳入研究进行筛选和资料提取并交叉核对。采用Review Manager 5.3软件进行分析评价。结果共纳入16个研究,包括1190例患者(其中实验组605例,对照组585例)。Meta分析结果:治疗组在止血时间[WMD=-9.48,95%CI(-13.46,-5.51),P<0.00001]、总有效率[OR=3.65,95%CI(2.48,5.37),P<0.00001]、输血量[WMD=-124.93,95%CI(-170.01,-79.85),P<0.00001]、并发症及不良反应事件发生率[OR=0.37,95%CI(0.19,0.69),P=0.002]上优于对照组,差异有统计学意义(P<0.05)。结论中西医结合治疗肝硬化上消化道出血能显著提高患者治疗总有效率,缩短止血时间及减少输血量,且安全性等各方面较单纯西药治疗更好,拓宽了治疗肝硬化上消化道出血的治法思路,值得临床参考和推广。

Objective To systematically investigate the clinical safety and efficacy of integrated traditional Chinese and western medicine in treating liver cirrhosis with upper gastrointestinal bleeding(UGIB),thus to provide evidence for clinical treatment of liver cirrhosis with UGIB.Methods We collected randomized controlled trials(RCTs)whose therapy of liver cirrhosis with UGIB was integrated traditional Chinese and western medicine from Pubmed,Embase,the Cochrane Library,CNKI,Chinese Biological and Medical Database(CBM),Wanfang database,VIP databases by computer retrieval.According to the inclusion and exclusion criteria of literature,the screening of RCTs and the data extract and cross checkd were performed by two researchers independently.And Review Manager 5.3 software was adopted to perform Meta-analysis.Results 16 documents were selected,including 1190 patients which were divided into the experimental group(605 cases)and the control group(585 cases).The meta-analysis showed that the hemostatic time[WMD=-9.48,95%CI(-13.46,-5.51),P<0.00001]the total efficiency[OR=3.65,95%CI(2.48,5.37),P<0.00001],blood transfusion amout[WMD=-124.93,95%CI(-170.01,-79.85),P<0.00001]and the rate of complications and adverse events[OR=0.37,95%CI=(0.19,0.69),P=0.002]in the experimental group were better than those in the control group and the difference was statistically significant.Conclusion Integrated traditional Chinese and western medicine in treating liver cirrhosis with UGIB can significantly enhance the clinical efficacy,shorten the bleeding time and decrease the amount of blood transfusion,and security and various aspects were better than western medicine treatment.It widens the treatment thought of liver cirrhosis with upper gastrointestinal bleeding,which was worth clinical reference and promotion.