化痰祛瘀法联合西药治疗胃癌前病变的Meta分析

Meta-analysis of Dissipating Phlegm and Removing Blood Stasis Combined with Western Medicine in the Treatment of Gastric Precancerous Lesions

目的系统评价化痰祛瘀法联合西药治疗胃癌前病变的临床疗效及安全性。方法检索知网、维普、万方、PubMed数据库中“化痰祛瘀法联合西药治疗胃癌前病变”的相关文献,检索时限为建库至2021年11月。据纳入、排除标准筛选文献,提取所需资料数据,采用Revman 5.4软件进行分析,评价单纯西药与化痰祛瘀法联合西药治疗胃癌前病变的临床疗效、胃脘痛症状改善情况、血清胃蛋白酶原水平、胃黏膜病理变化以及不良反应发生率。结果纳入8个研究,745例患者,其中治疗组(化痰祛瘀法联合西药)375例,对照组(西药)370例;Meta分析显示,与对照组比较,治疗组胃黏膜病理变化改善[胃黏膜萎缩(MD=-0.76,95%CI:-1.40~-0.13)、肠上皮化生(MD=-0.51,95%CI:-0.74~-0.28)、异型增生(MD=-0.53,95%CI:-0.76~-0.30)]及胃脘痛症状改善(MD=-0.78,95%CI:-1.28~-0.28)优于对照组,临床总有效率高于对照组(RR=1.25,95%CI:1.15~1.35),差异有统计学意义(P<0.05);两组血清PGⅠ(MD=18.08,95%CI:0.08~36.08)、PGⅡ(MD=1.21,95%CI:-5.44~7.85)水平及不良反应发生率(RR=1.67,95%CI:0.42~6.66)比较,差异无统计学意义(P>0.05)。结论化痰祛瘀法联合西药治疗胃癌前病变能更好的提高临床总有效率,改善胃脘痛症状、胃黏膜病理改变及血清PGⅠ、PGⅡ水平,具有较好的安全性。

Objective To evaluate the clinical efficacy and safety of dissipating phlegm and removing blood stasis combined with Western medicine in the treatment of precancerous lesions of gastric cancer.Methods The relevant literature of“dissipating phlegm and removing blood stasis combined with Western medicine in the treatment of precancerous lesions of gastric cancer”in CNKI,VIP,Wanfang and PubMed databases were retrieved,and the retrieval time was from database establishment to November 2021.According to the inclusion and exclusion criteria,the literature was screened,and the required data were extracted.Revman 5.4 software was used to analyze and evaluate the clinical efficacy of simple Western medicine and dissipating phlegm and removing blood stasis combined with Western medicine in the treatment of precancerous lesions of gastric cancer,the improvement of epigastric pain symptoms,serum pepsinogen level,pathological changes of gastric mucosa and the incidence of adverse reactions.Results A total of 745 patients were included in eight studies,including 375 patients in the treatment group(dissipating phlegm and removing blood stasis combined with Western medicine)and 370 patients in the control group(western medicine).Meta-analysis showed that compared with the control group,the improvement of gastric mucosal pathological changes[gastric mucosal atrophy(MD=-0.76,95%CI:-1.40 to-0.13),intestinal metaplasia(MD=-0.51,95%CI:-0.74 to-0.28),dysplasia(MD=-0.53,95%CI:-0.76 to-0.30)]and epigastric pain symptoms(MD=-0.78,95%CI:-1.28to-0.28)in the treatment group were better than those in the control group,and the total clinical response rate was higher than that in the control group(RR=1.25,95%CI:1.15 to 1.35),the difference was statistically significant(P<0.05);there was no significant difference in serum PGⅠ(MD=18.08,95%CI:0.08 to 36.08),PGⅡ(MD=1.21,95%CI:-5.44 to 7.85)levels and incidence of adverse reactions(RR=1.67,95%CI:0.42 to 6.66)between the two groups(P>0.05).Conclusion Dissipating phlegm and removing blood stasis combined with Western medicine in the treatment of precancerous lesions of gastric cancer can better improve the clinical total effective rate,improve epigastric pain symptoms,gastric mucosal pathological changes and serum PGⅠ,PGⅡ levels,with good safety.