炙甘草汤合猪苓汤治疗肝硬化腹水有效性的Meta分析

Efficacy of Zhigancao Decoction Combined with Zhuling Decoction on Ascites in Cirrhosis: A Meta-Analysis

目的:系统评价炙甘草汤合猪苓汤治疗肝硬化腹水的有效性。方法:计算机系统检索PubMed、EMbase、The Cochrane Library、Web of Science、万方、中国知网、维普及中国生物医学文献数据库,收集炙甘草汤合猪苓汤治疗肝硬化腹水的随机对照试验,检索时限均为建库至2020年7月。由2名研究者独立筛选研究、提取数据并评价纳入研究的偏倚风险。采用RevMan 5.4软件合并研究数据。结果:共纳入11个试验,包括769例患者。Meta分析结果显示:试验组的有效率[RR=1.28,95%CI(1.16,1.42),P<0.00001]、血清白蛋白[MD=8.94 g/L,95%CI(7.86,10.01),P<0.00001]、凝血酶原活动度[MD=8.55%,95%CI(3.42,13.67),P=0.001]、腹水消退时间[MD=-2.11 d, 95% CI(-2.42,-1.81),P<0.00001]、腹胀消退时间[MD=-2.78 d, 95%CI(-3.93,-1.63),P<0.00001]、下肢水肿消退时间[MD=-2.38 d, 95%CI(-2.65,-2.10),P<0.00001]、肝区疼痛消失时间[MD=-1.92 d, 95%CI(-2.72,-1.57),P<0.00001]均优于对照组(常规治疗)。结论:当前证据表明,炙甘草汤合猪苓汤治疗肝硬化腹水患者的效果优于常规治疗。但受纳入研究数量和质量的限制,上述结论尚需开展更多大样本、高质量的临床研究予以验证。

Objective: To systematically evaluate the efficacy of Zhigancao Decoction combined with Zhuling decoction on ascites in liver cirrhosis. Methods: Randomized controlled trials(RCTs) of Zhigancao Decoction combined with Zhulin Decoction for the ascites due to cirrhosis were collected by the computer retrieval from Pub Med, EMbase, The Cochrane Library, Web of Science, Wan Fang, CNKI, VIP and CBM databases, from the establishment to July 2020. After two researchers independently screened the literature, extracted the data and evaluated the risk of bias of included studies. RevMan 5.4 software was used to conduct the Meta-analysis and data merge. Results: A total of 11 RCTs were included, and 769 patients were included. Meta-analysis results showed that: in the treatment group, the effective rate [RR=1.28, 95%CI(1.16,1.42),P<0.00001],the level of serum albumin [MD=8.94(g/L), 95%CI(7.86,10.01),P<0.00001],the prothrombin activity [MD=8.55(%),95%CI(3.42,13.67),P=0.001],regression time of ascites [MD=-2.11(d), 95%CI(-2.42,-1.81)],P<0.00001],regression time of ventosity [MD=-2.78(d), 95%CI(-3.93,-1.63),P<0.00001], regression time of edema of lower extremities [MD=-2.38(d), 95%CI(-2.65,-2.10),P<0.00001], and disappearance time of liver pain [MD=-1.92(d), 95%CI(-2.72,-1.57),P<0.00001] were all superior than those in the control group(conventional therapy). Conclusion: Current evidence shows that the efficacy of Zhigancao Decoction combined with Zhuling Decoction in the treatment of ascites due to cirrhosis is better than that of the conventional treatment. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more and high-quality trials.