益气健脾和胃法治疗慢性萎缩性胃炎的Meta分析

Meta-Analysis on the Treatment of Chronic Atrophic Gastritis with the Method of Invigorating Qi and Strengthening Spleen and Stomach

目的:系统评价益气健脾和胃法在治疗慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)的安全性和有效性。方法:中文文献检索CNKI、Wan Fang Data、VIP、CBM;外文文献检索PubMed、Cochrane library数据库,收集自建库至2021年12月所有严格符合纳入标准的益气健脾和胃法治疗CAG的随机对照试验,运用RevMan 5.3软件对主要的结局指标进行Meta分析操作。结果:纳入22篇随机对照文献,总共有样本量1912名,其中实验组有974例样本量,对照组有938例样本量。Meta分析结果显示:实验组与对照组相比,在临床有效率(OR=5.06,95%CI[3.72,6.89],P<0.05)、Hp转阴率(OR=3.72,95%CI[2.18,6.35],P<0.05)、降低不良反应发生率(OR=0.3[0.17,0.56],P<0.05)方面均优于对照组,在改善中医症状总积分(MD=-2.5,95%CI[-3.27,-1.74],P<0.05)、胃脘疼痛(MD=-0.72,95%CI[-1.13,-0.32],P<0.05)、胃脘胀满(MD=-0.71,95%Cl[-0.97,-0.45],P<0.05)、嗳气泛酸(MD=-0.35,95%CI[-0.53.-0.17],P<0.05)、饮食减少(MD=-0.44,95%CI[-0.71,-0.16],P<0.05),实验组与对照组相比,均有所下降;在胃镜病理(MD=-3.12,95%CI[-4.97,-1.27],P<0.05),实验组优于对照组;在血清指标方面,对PG I、PG II及PGR方面,实验组都优于对照组。结论:益气健脾和胃法联合西药治疗慢性萎缩性胃炎,与单纯西药治疗相比,在临床总有效率、胃镜病理有效率及Hp转阴率方面,均能显著提高,且不良反应发生少,在改善中医总症状积分、胃脘胀满、胃脘疼痛、嗳气泛酸、饮食减少等反面均优于单纯西药,安全可靠。但由于本Meta分析原始文献质量偏低、偏倚风险较高,影响了结果的准确性和真实性。

Objective: To systematically evaluate the safety and effectiveness of the method of invigorating qi and strengthening spleen and stomach in the treatment of chronic atrophic gastritis(CAG). Methods: Chinese literature search CNKI, Wan Fang Data, VIP, CBM;Foreign literature search PubMed and Cochrane library databases, collect all randomized controlled trials of supplementing qi and strengthening spleen and stomach therapy for CAG that strictly meet the inclusion criteria from the establishment of the database to December 2021, and use RevMan 5.3 software to perform Meta-analysis on the main outcome indicators. Results: 22 randomized controlled literatures were included, with a total sample size of 1912, including 974 samples in the experimental group and 938 samples in the control group. Meta-analysis results showed that: compared with the control group, the experimental group was superior to the control group in clinical efficiency(OR = 5.06, 95% CI(3.72, 6.89], P < 0.05), Hp overcast rate(OR = 3.72, 95% CI(2.18, 6.35], P <0.05), adverse reaction rate(OR=0.3[0.17,0.56], P<0.05), total score of TCM symptoms(MD=-2.5,95%CI[-3.27,-1.74], P<0.05), epigastric pain(MD=-0.72,95%CI[-1.13,-0.32], P<0.05), stomach fullness(MD=-0.71, 95%Cl[-0.97,-0.45], P<0.05), belching pantothenic acid(MD=-0.35,95%CI[-0.53.-0.17], P<0.05), and diet reduction(MD=-0.44,95%CI[-0.71,-0.16], P<0.05), were all decreased in the experimental group compared with the control group;In gastroscopic pathology(MD=-3.12, 95%CI[-4.97,-1.27], P<0.05), the experimental group was superior to the control group. In terms of serum indicators, the experimental group was superior to the control group in terms of PG I, PG II and PGR. Conclusion: The method of replenishing qi and strengthening spleen and stomach combined with western medicine in the treatment of chronic atrophic gastritis can significantly improve the clinical total effective rate, the pathological effective rate of gastroscopy and the negative rate of Hp compared with the simple western medicine, and has fewer adverse reactions. It is safer and more reliable than the simple western medicine in improving the total symptom score of traditional Chinese medicine, gastric distension, epigastric pain,belching and pantothenic acid, and diet reduction. However, due to the low quality of the original literature and the high risk of bias, the accuracy and authenticity of the results are affected.