黄芪建中汤加减治疗脾胃虚寒型胃痛有效性和安全性的系统评价及Meta分析

A systematic evaluation and meta-analysis of efficacy and safety of the Huangqi Jianzhong decoction on stomachache with deficiency and cold type of spleen and stomach

目的:评估黄芪建中汤加减治疗脾胃虚寒(弱)型胃痛的疗效及安全性。方法:计算机检索The Cochrane Library、PubMed、中国知网、维普、万方、中国生物医学数据库的中英文文献,检索时间为建库至2020年7月。筛选单用黄芪建中汤治疗脾胃虚寒(弱)型胃痛的随机对照试验为研究对象,参照Cochrane手册对纳入文献进行质量评价,采用RevMan 5.3.5软件进行Meta分析。结果:共纳入26项研究,其中涉及胃痛2项,慢性胃炎15项,消化性溃疡9项,共计2481例患者;纳入文献均以临床症状改善、胃镜下炎症改善情况、幽门螺杆菌转阴率、疾病复发率及不良反应发生率等作为评价指标;Meta分析结果示黄芪建中汤治疗胃痛的临床疗效优于西药,尤其在改善胃黏膜炎症、降低复发率和不良反应发生率方面效果明显,差异有统计学意义;但对溃疡患者胃黏膜的改善方面与西药相比无明显优势,差异无统计学意义。亚组分析显示其疗效在胃痛、胃炎和溃疡的不同疾病之间的差异无统计学意义。结论:与常规西药相比,单用黄芪建中汤能明显缓解患者的胃脘疼痛、畏寒肢冷等脾胃虚寒(弱)症状,促进胃黏膜炎症修复,远期效果稳定且安全,对幽门螺杆菌也有一定的抑杀作用。但受文献质量的影响,此结论仍需更多高质量的随机对照试验予以验证。

Objective:To systematically evaluate the efficacy and safety of the Huangqi Jianzhong decoction(黄芪建中汤)on stomachache with deficiency and cold type of spleen and stomach.Methods:The Cochrane Library,PubMed,CNKI,VIP,Wanfang Data,and CBM databases until July 2020 were searched by computer.Randomized Controlled trials of the Huangqi Jianzhong decoction on gastric pain of spleen and stomach deficiency and cold(weak)type was selected as the research object.Referring to the Cochrane Handbook,the included literature was evaluated for quality.Meta-analysis was performed using RevMan 5.3.5 software.Results:A totals of 26 randomized controlled trial with 2481 patients,including 2 studies on stomachache,15 studies on chronic gastritis,and 9 studies on peptic ulcer.The improvement of clinical symptoms and gastric mucosal inflammation,Hp negtive rate,recurrence rate and adverse reactions were used as the outcome indicators of the included literature;meta-analysis showed that the Huangqi Jianzhong decoction had better efficacy than Western medicine,especially in improving gastric mucosal inflammation under gastroscope,reducing the recurrence rate and adversing reaction rate,P<0.05.The subgroup analysis showed that there was no significant difference in the efficacy among different diseases of stomach pain,gastritis and ulcer.Conclusion:Compared With western medicine,the Huangqi Jianzhong decoction can alleviate the symptoms of deficiency and cold of spleen and stomach,such as epigastric pain,cold limbs,etc.,and promote the repair of gastric mucosal inflammation,the long-term effect was stable and safe,and also has certain effect on inhibiting Helicobacter pylori.However,due to the quality of the literature,the validity of the conclusion needs more high-quality RCT evidence.