针对本虚标实的病机以理气健脾清热利湿活血解毒法治疗慢性萎缩性胃炎伴肠上皮化生的Meta分析

A Meta-analysis on the treatment of CAG with IM by regulating Qi and invigorating spleen,clearing heat and dampness,and activating blood and detoxifying according to the pathogenesis of deficiency in origin and excess in superficiality

目的:通过对纳入的采用理气健脾清热利湿活血解毒法治疗慢性萎缩性胃炎(Chronic Atrophic Gastritis,CAG)伴肠上皮化生(Intestinal Metaplasia,IM)的临床随机对照文献进行Meta分析,为运用中药汤剂治疗CAG伴IM提供进一步的证据支持,从而逆转IM,降低胃癌的发生率及病死率。方法:对发表在中国知网、万方、维普、PubMed的中医药疗法治疗CAG伴IM的临床随机对照试验进行检索,应用Cochrane文献质量评价工具对纳入本研究的文献进行质量评价,并通过统计学软件Rev Man 5.4.1对纳入文献进行分析。结果:共纳入文献63篇,共5913例患者,采用Cochrane文献质量评价工具对其进行质量评价。Meta分析结果显示:理气健脾清热利湿活血解毒法治疗CAG伴IM在临床疗效、胃镜疗效及积分、病理疗效及病理积分、中医证候疗效、幽门螺杆菌(Helicobacter pylori,Hp)根除率等方面优于单纯西药对症治疗,其差异均有统计学意义(P<0.00001);在改善胃胀、痞满、胃痛等症状及安全性方面,理气健脾清热利湿活血解毒法亦优于西药常规治疗。结论:理气健脾清热利湿活血解毒法治疗CAG伴IM较西药常规治疗及胃复春临床疗效更好,胃镜及病理疗效显著,Hp根除率高,并且安全有效,可为临床治疗提供组方思路。

Objective:To provide further evidence for the use of traditional Chinese medicine decoction in the treatment of chronic atrophic gastritis(CAG)with intestinal metaplasia(IM)by Meta-analysis of randomized controlled clinical literature on the treatment of chronic atrophic gastritis with intestinal metaplasia by regulating Qi(气),strengthening spleen,clearing heat,promoting blood circulation and detoxification(LQJPQRLSHXJD),so as to reverse intestinal metaplasia and reduce the incidence and mortality of gastric cancer.Methods:Randomized controlled trials published in CNKI,Wanfang,VIP and PubMed on the treatment of CAG with IM were retrieved.Cochrane literature quality assessment tool was used to evaluate the quality of the included literature.Statistical software Rev Man 5.4.1 was used to analyze the included literature.Results:A total of 63 studies were included,including 5913 patients.Cochrane literature quality assessment tool was used to evaluate the quality of the studies.The results of Meta-analysis showed that LQJPQRLSHXJD method was superior to Western medicine alone in the treatment of CAG with IM in terms of clinical efficacy,endoscopic efficacy and score,pathological efficacy and score,TCM syndrome efficacy,and Hp eradication rate,and the differences were statistically significant(P<0.00001).The LQJPQRLSHXJD method was also superior to the conventional treatment of Western medicine in ameliorating the symptoms of stomach distension,ruffia and stomachache and its safety.Conclusion:LQJPQRLSHXJD has better clinical efficacy than conventional Western medicine and gastrectomy in the treatment of CAG with IM.The gastroscopic and pathological effects are significant,the eradication rate of Hp is high,and it is safe and effective,which can provide prescription ideas for clinical treatment of CAG with IM.