茵陈蒿汤加减治疗急性重症胆管炎胆道减压引流术后疗效的Meta分析

Meta analysis of therapeutic effect of using modified Yinchenhao Decoction for treatment of acute severe cholangitis after biliary decompression and drainage

目的系统评价胆道减压引流术后应用茵陈蒿汤加减治疗急性重症胆管炎(ACST)的临床疗效.方法通过检索美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、Google学术、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库(VIP)等公开发表的胆道减压引流术后应用茵陈蒿汤加减治疗ACST的随机对照试验(RCT).对照组为常规西医治疗,试验组为常规西医治疗基础上联用茵陈蒿汤加减治疗.按照纳入、排除标准筛选文献及提取数据资料,运用Cochrane风险偏倚评估工具进行质量评价,采用RevMan 5.3软件对相关数据进行统计分析,比较茵陈蒿汤加减治疗ACST胆道减压引流术后患者的临床效果.结果共纳入6项研究、累计373例患者,其中试验组189例,对照组184例.Meta分析结果显示:①肝功能指标:与单纯常规西医治疗相比,联用茵陈蒿汤加减治疗可明显降低患者总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平〔TBil:均数差(MD)=-31.19,95%可信区间(95%CI)为-49.18~-13.20,P=0.0007;DBil:MD=-15.23,95%CI为-22.80~-7.66,P<0.0001;ALT:MD=-30.82,95%CI为-48.67~-12.98,P=0.0007;AST:MD=-24.10,95%CI为-37.51~-10.70,P=0.0004〕.②住院时间:与单纯常规西医治疗相比,联用茵陈蒿汤加减治疗可有效缩短患者的住院时间(MD=-6.85,95%CI为-7.98~-5.73,P<0.00001).③临床有效率:与单纯常规西医治疗相比,联用茵陈蒿汤加减治疗可有效提高ACST的临床有效率(OR=3.46,95%CI为1.21~9.89,P=0.02).结论应用茵陈蒿汤加减治疗ACST胆道减压引流术后患者的疗效确切,能够明显促进患者肝功能恢复,缩短住院时间,提高临床有效率.但受纳入研究质量及样本量等因素的限制,上述结论尚需开展多中心、大样本、高质量的RCT进一步验证.

Objective To systematically evaluate the clinical efficacy of using modified Yinchenhao Decoction in the treatment of patients with acute severe cholangitis(ACST)after operation of biliary decompression and drainage.Methods We searched PubMed,Embase,Google Scholar,China Journal Full-text Database(CNKI),China Biomedical Literature Database(CBM),Wanfang Database,VIP Database(VIP)and other published randomized controlled trials(RCF)of modified Yinchenhao Decoction in treatment of ACST after biliary tract decompression and drainage.The control group was treated with routine Western medicine,and the experimental group was treated with modified Yinchenhao Decoction on the basis of conventional Western medicine.According to the inclusion and exclusion criteria,the literature and extracted data were screened,the quality was evaluated by Cochrane risk bias assessment tool,the related data were statistically analyzed by RevMan 5.3 soft ware,and the clinical effects of modified Yinchenhao Decoction in the treatment of patients with ACST after biliary decompression and drainage were compared between the two groups.Results A total of 373 patients were enrolled in 6 studies,including 189 in the experimental group and 184 in the control group.Meta analysis results showed that:① Indexes of liver function:compared with the conventional Western medicine treatment alone,the combined Western and modified Yinchenhao Decoction treatment could significantly reduce the levels of total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)[TBil:mean difference(MD)=-31.19,95%confidence interval(95%CI)was-49.18 to-13.20,P=0.0007;DBil:MD=-15.23,95%CI was-22.80 to-7.66,P<0.0001;ALT:MD=-30.82,95%CI was-48.67 to-12.98,P=0.0007;AST:MD=-24.10,95%CI was-37.51 to-10.70,P=0.0004].②Hospitalization time:compared with routine Western medicine treatment alone,the combination of Western medicine and modified Yinchenhao Decoction treatment could effectively shorten the hospitalization time of patients(MD=-6.85,95%CI=-7.98 to-5.73,P<0.00001).③Clinical effective rate:compared with routine Western medicine treatment alone,the combination Western medicine and modified Yinchenhao Decoction treatment can effectively improve the clinical effective rate of ACST(OR=3.46,95%CI was 1.21 to 9.89 P=0.02).Conclusions Modified Yinchenhao Decoction is certainly effective in the treatment of patients with ACST after biliary decompression and drainage,since it can significantly promote the recovery of liver function,shorten the time of hospitalization and improve the clinical effective rate.However,due to the limitations of the inclusion of research quality and sample size and other factors,the above conclusions need to be further verified by multicenter,large sample and high quality RCT.