经方治疗肝胃郁热型胃食管反流病的网状Meta分析

Network Meta-analysis of jingfang for gastroesophageal reflux disease of stagnation-heat in liver and stomach

[目的]系统评价经方治疗肝胃郁热型胃食管反流病(GERD)的临床疗效。[方法]计算机检索中国期刊全文数据库(CNKI)、万方数据库、中国科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBMdisc)、PubMed、Embase、和Cochrane图书馆,收集经方治疗肝胃郁热型GERD的随机对照试验(RCT),检索时限为自数据库收录以来至2020年11月正式发表文献,以及中、美国临床试验注册中心已有公开试验结果但未发表的文献,对纳入文献进行质量评价,采用RevMan 5.3软件及Stata 15.0软件进行统计分析。[结果]共纳入16篇文献,合计1 501例患者,涉及7个经方:左金丸、旋覆代赭汤、香附旋复花汤、四逆散、大柴胡汤、柴芍六君汤合左金丸、柴胡疏肝散加味。传统Meta分析结果显示:左金丸、香附旋复花汤、柴芍六君汤合左金丸的总有效率均高于质子泵抑制剂(PPI)+促动力药;左金丸、旋覆代赭汤、柴胡疏肝散加味的总有效率均高于PPI。网状Meta分析结果显示:在总有效率方面,香附旋复花汤、柴芍六君汤合左金丸、柴胡疏肝散加味、旋覆代赭汤、左金丸、大柴胡汤、四逆散、PPI+促动力药均高于PPI;香附旋复花汤、柴芍六君汤合左金丸高于PPI+促动力药、旋覆代赭汤,以上结果差异均有统计学意义(P<0.05)。总有效率概率排序结果显示:柴芍六君汤合左金丸>香附旋复花汤>左金丸>四逆散>大柴胡汤>柴胡疏肝散加味>PPI+促动力药>旋覆代赭汤>PPI。[结论]经方治疗GERD优于PPI;与PPI联合促动力药比较,香附旋复花汤、柴芍六君汤合左金丸、左金丸的总有效率显著更高。各经方之间两两比较,香附旋复花汤、柴芍六君汤合左金丸的总有效率显著高于旋覆代赭汤。柴芍六君汤合左金丸的疗效最佳可能性大。

[Objective]To systematically evaluate the clinical effects of Jingfang in the treatment of gastroesophageal reflux disease(GERD)of stagnation-heat in liver and stomach.[Methods]CNKI,Wanfang, VIP,CBMdisc, PubMed, Embase and the Cochrane library were searched online from inception to November 2020 to collect randomized controlled trials on the treatment of GERD of Stagnation-heat in Liver and Stomach with Jingfang.And search the unpublished literature that has have published the results of the trial from the clinical trial registration centers in China and the United States.The quality evaluation was done on the included literatures.RevMan 5.3 and Stata 15.0 software were used for statistical analysis.[Results]Sixteen articles were included, including 1 501 patients, involving 7 kinds of Jingfang: Zuojin pill, Xuanfudaizhe decoction, Xiangfuxuanfuhua decoction, Sini powder, Dachaihu decoction, Chaishaoliujun decoction combined Zuojin pill and modified Chaihushugan powder.The results of traditional Meta-analysis showed the total effective rates of Zuojin pill, Xiangfuxuanfuhua decoction and Chaishaoliujun decoction combined Zuojin pill were higher than that of PPI combined prokinetic drugs.The total effective rates of Zuojin pill, Xuanfudaizhe decoction and modified Chaihushugan powder were higher than that of PPI.The results of Network Meta-analysis showed the total effective rates of 7 kinds of Jingfang and PPI combined prokinetic drugs were higher than that of PPI.The total effective rates of Xiangfuxuanfuhua decoction and Chaishaoliujun decoction combined Zuojin pill were higher than that of PPI combined prokinetic drugs and Xuanfudaizhe decoction.The above results are statistically significant(P<0.05).The total effective probability ranking result was Chaishao lLiujun decoction combined Zuojin pill>Xiangfuxuanfuhua decoction>Zuojin pill>Sini powder>Dachaihu decoction>modified Chaihushugan powder>PPI combined prokinetic drugs>Xuanfudaizhe decoction>PPI.[Conclusion]The existing research evidence shows that in terms of curative ceffect, Jingfang is better than PPI in the treatment of GERD.Compared with PPI combined prokinetic drugs, the total effective rate of Xiangfuxuanfuhua decoction and Chaishaoliujun decoction combined Zuojin pill is significantly improved.Comparison between 7 kinds of Jingfang, the total effective rate of Xiangfuxuanfuhua decoction and Chaishaoliujun decoction combined Zuojin pill is significantly higher than that of Xuanfudaizhe decoction.Chaishaoliujun decoction combined Zuojin pill are most likely to have the best curative effect.