大柴胡汤加减联合内镜对肝胆湿热型急性胆源性胰腺炎临床疗效的Meta分析

Meta analysis on the clinical efficacy of Dachaihu decoction plus endoscopic duodenal for acute biliary pancreatitis with syndrome of damp-heat in liver and gallbladder

目的:采用Meta分析方法评价大柴胡汤加减联合十二指肠内镜治疗肝胆湿热型急性胆源性胰腺炎的有效性。方法:计算机检索Pubmed、Web of Science、Cochrane Library、CNKI、VIP、万方及CBM等数据库,检索时限为建库至2022年6月,2名评价者独立筛选文献、提取资料和评价纳入研究偏倚后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入5项随机对照试验研究,总病例数463例。分析结果显示,大柴胡汤加减联合内镜治疗肝胆湿热型急性胆源性胰腺炎在提高总有效率[OR=3.75,95%CI(2.13,6.62),P<0.001],缩短血淀粉酶恢复正常时间、尿淀粉酶恢复正常时间、腹胀缓解时间、腹痛缓解时间、首次排便时间,降低APACHE-Ⅱ评分方面均优于对照组,差异有统计学意义。结论:大柴胡汤加减联合十二指肠内镜治疗肝胆湿热型急性胆源性胰腺炎在提高总有效率、迅速缓解症状、缩短各项指标恢复时间方面有一定疗效,但纳入文献质量偏低,需高质量随机对照试验进一步验证。

Objective To evaluate the effectiveness of modified Dachaihu decoction plus endoscopic duodenal for the treatment of acute biliary pancreatitis(ABP)with syndrome of damp-heat in liver and gallbladder by Meta-analysis.Methods The Pubmed,Cochrane Library,Web of Science,CNKI,VIP,Wanfang data and CBM databases were retrieved from the time of database establishment to June 2022.Two reviewers screened the literatures,extracted data and evaluated the bias of the included trials independently.Afterwards,using RevMan 5.3 software,the meta-analysis was conducted.Results A total of 5 trials involving 463 patients were included into the analysis.The analysis results shows that modified Dachaihu decoction plus endoscopic duodenal for the treatment of ABP with syndrome of damp-heat in liver and gallbladder had stronger effect on increasing overall effective rate[OR=3.75,95%CI(2.13,6.62),P<0.001],shortening the recovery time of amylase in blood and in urine,shortening the abdominal distension relief time,shortening the abdominal pain relief time,shortening the first defecation time,and reducing the score of APACHE-Ⅱ.And the differences were statistically significant.Conclusion The treatment of modified Dachaihu decoction plus endoscopic duodenal has a certain effect on the ABP with syndrome of damp-heat in liver and gallbladder in increasing overall effective rate,rapidly alleviating symptoms and shortening the recovery time of various indicators.But the quality of the included literatures is low,and the conclusion needs more RCTs of high quality to give a further verification.