活血化瘀法治疗原发性血小板增多症疗效与安全性的Meta分析

A Meta-analysis of the efficacy and safety of activating blood circulation and removing blood stasis therapy in the treatment of essential thrombocythemia

目的:运用Meta分析的方法估活血化瘀法治疗原发性血小板增多症的疗效与安全性,为临床提供参考。方法:检索中国知网、万方、维普中文期刊、中国生物医学文献数据库,统计关于单独或联合使用活血化瘀中药治疗原发性血小板增多症的临床研究文献,将文献用RevMan 5.3软件对疗效和安全性进行Meta分析。结果:本研究共纳入文献19篇,患者936例。西医联合活血化瘀中药治疗结果:西医总有效率得到提高(OR=3.97,95%CI[2.66,5.93]);中医证候有效率得到提高(OR=11.92,95%CI[5.04,28.22]);血小板计数降低(MD=219.62,95%CI[209.91,229.32])。单独使用活血化瘀中药治疗结果:中医证候有效率得到提高(OR=3.39,95%CI[1.28,9.00]);不良反应(OR=0.20,95%CI[0.06,0.66])比西医低;但与西医常规治疗对比,在提高西医总有效率(OR=2.31,95%CI[0.92,5.83])、降低血小板计数(MD=5.85,95%CI[-39.99,51.70])方面的差异无统计学意义。研究结果未发现存在发表偏倚。证据质量偏低。结论:单独使用活血化瘀中药不良反应少,可提高证候有效率,但无法达到改善降低血小板计数的主要目的;在西医治疗的基础上联合使用活血化瘀中药的疗效优于单纯西医治疗。由于纳入研究的质量一般,结论仍需后续高质量试验加以验证。

Objective:To systematically evaluate the efficacy and safety of activating blood circulation and removing blood stasis therapy in the treatment of essential thrombocythemia by a Meta-analysis,so as to provide evidence-based medical evidence for clinical treatment.Methods:The databases of CNKI,Wanfang,VIP and CBM were retrieued to count the clinical research literature on essential thrombocythemia treated by TCM activating blood circulation and removing blood stasis therapy alone or in combination,Meta-analysis of efficacy and safety was performed using RevMan 5.3 software.Results:A total of 19 articles and 936 patients were included in this study.Results of Western medicine combined with TCM for promoting blood circulation and removing blood stasis:the total efficiency of Western medicine was improved(OR=3.97,95%CI[2.66,5.93]);the effective rate of TCM symptoms was improved(OR=11.92,95%CI[5.04,28.22]);the platelet count was decreased(MD=219.62,95%CI[209.91,229.32]).The results of the treatment of activating blood circulation and removing blood stasis with TCM alone:the effective rate of TCM symptoms was improved(OR=3.39,95%CI[1.28,9.00]),the incidence of adverse reactions(OR=0.20,95%CI[0.06,0.66])was lower than that of Western medicine;however,compared with the conventional treatment of Western medicine,there was no statistical significance in improving the total effective rate of Western medicine(OR=2.31,95%CI[0.92,5.83])and reducing platelet count(MD=5.85,95%CI[-39.99,51.70]).Publication bias was not found in the study results.The quality of evidence was low.Conclusion:The single use of TCM for activating blood circulation and removing blood stasis has fewer adverse reactions,which can improve the effective rate of symptoms,but cannot improve the main purpose of reducing platelet count.On the basis of Western medicine treatment,the combined use of TCM and Western medicine to promote blood circulation and remove blood stasis is superior to Western medicine treatment alone.Due to the general quality of the included study,the conclusion still needs to be verified by subsequent high-quality experiments.