参苓白术散联合美沙拉嗪治疗溃疡性结肠炎的Meta分析

Meta-analysis of Shenling Baizhu Powder(参苓白术散)combined with Mesalazine in the Treatment of Ulcerative Colitis

目的:系统评价参苓白术散联合美沙拉嗪治疗溃疡性结肠炎(UC)的临床疗效,为临床应用提供循证参考。方法:计算机检索中国期刊全文数据库(CNKI)、万方数据库、维普数据库、PubMed、Cochrane图书馆、中国生物医学数据库(CBM),收集参苓白术散联合美沙拉嗪制剂(试验组)对比美沙拉嗪制剂单用(对照组)治疗UC的随机对照试验(RCT),按照Corchane系统评价方法评价文献质量后,采用RevMan 5.4统计软件进行Meta分析。结果:最终纳入17篇RCT,包括1263例患者。Meta分析结果显示,试验组患者总有效率高于对照组[OR=2.03,95%CI(1.60,2.58),P<0.00001],试验组患者白细胞介素-17(IL-17)[MD=-88.29,95%CI(-100.37,-76.21),P<0.00001]、IL-23[MD=-115.34,95%CI(-130.69,-99.99),P<0.00001]、肿瘤坏死因子-α(TNF-α)[MD=-10.64,95%CI(-11.65,-9.64),P<0.00001]、血沉(ESR)[MD=-8.22,95%CI(-9.31,-7.12),P<0.00001]、C反应蛋白(CRP)[MD=-6.74,95%CI(-9.99,-3.48),P<0.00001]水平均低于对照组,差异均有统计学意义。结论:参苓白术散联合美沙拉嗪制剂治疗UC的临床疗效优于单用美沙拉嗪制剂,还可改善UC的炎症因子水平。本结论还需更多高质量、大样本、双盲随机对照试验的进一步论证。

Objective:To systematically evaluate the efficacy of Shenling Baizhu Powder(参苓白术散,SLBZP)combined with mesalazine in the treatment of ulcerative colitis(UC)and provide evidence-based reference for clinical application.Methods:The Chinese journal full text database(CNKI),Wanfang database,VIP database,PubMed,Cochrane Library and China biomedical database(CBM)were searched by computer to collect th e randomized controlled trials(RCTs)of SLBZP combined with mesalazine preparation(test group)compared with mesalazine preparation alone(control group)in the treatment of UC.After evaluating the literature quality according to the Corchane system evaluation method,Revman5.4 statistical software was used for meta-analysis.Results:A total of 17 RCTs were finally included,including 1263 patients.The results of Meta-analysis showed that the total effective rate of patients in the test group was higher than that in the control group[OR=2.03,95%CI(1.60,2.58),P<0.05].The level of Interleukin(IL-17)[MD=-88.29,95%CI(-100.37,-76.21),P<0.00001],IL-23[MD=-115.34,95%CI(-130.69,-99.99),P<0.00001],Tumor necrosis facter-α(TNF-α)[MD=-10.64,95%CI(-11.65,-9.64),P<0.00001],Erythrocyte sedimentation rate(ESR)[MD=-8.22,95%CI(-9.31,-7.12),P<0.00001],and C-reactive protein(CRP)[MD=-6.74,95%CI(-9.99,-3.48),P<0.00001]in the test group were significantly lower than those in the control group.The differences were statistically significant.Conclusion:The clinical efficacy of SLBZP combined with mesalazine in the treatment of UC was better than mesalazine,and can also improve the level of inflammatory factors in UC.This conclusion needs further demonstration of more highquality,large sample,double-blind randomized controlled trials.