中药方剂治疗高脂血症急性胰腺炎临床疗效和安全性的系统评价与Meta分析

Systematic evaluation and Meta-analysis of the clinical efficacy and safety of TCM prescription in the treatment of hypertriglyceridemia acute pancreatitis

目的:对早期服用中药方剂治疗高脂血症急性胰腺炎(Hypertriglyceridemia acute Pancreatitis,HLAP)的临床疗效和安全性进行系统评价。方法:通过计算机检索Pub Med、Cochrane、Web of Science、中国生物医学文献数据库、中国知网、万方数据库、维普科技期刊数据库自建库至2022年2月发表的文献,根据纳入排除标准筛选后对入选文献进行评价,提取相关资料后使用Rev Man 5.4软件对治疗总有效率、血脂、淀粉酶、腹痛缓解时间、住院时间和不良反应进行系统评价与Meta分析。结果:共纳入8篇研究文献,病例总数为637例,其中中药治疗组320例、对照组317例。Meta分析结果表明:中药治疗组总有效率优于对照组[比值比(Odds Ratiio,OR)=3.63,95%置信区间(Confidence Interval,CI):2.10~6.3,P<0.01];中药治疗组三酰甘油下降水平优于对照组[均数差(Mean Difference,MD)=–1.38,95%CI:–2.60~–0.16,P=0.03];中药治疗组淀粉酶下降水平优于对照组(MD=–7.61,95%CI:–11.05~–4.16,P<0.01),住院时间显著缩短(MD=–1.20,95%CI:–1.70~–0.69,P<0.01),且未见药物不良反应报道。对上述Meta分析结果逐一排除个别研究,所得结论没有发生改变,说明结果具有一定的稳定性。对总有效率这一结果指标使用漏斗图进行发表偏倚检验,结果显示左右分布不完全对称,提示结果可能存在发表偏倚。结论:早期服用中药方剂能够提高HLAP临床疗效、缓解腹痛、降低血脂及淀粉酶水平、缩短住院时间,且未显示药物不良反应。

Objective:To systematically evaluate the clinical efficacy and safety of TCM prescription in the treatment of hypertriglyceridemia acute pancreatitis.Methods:The literature published in PubMed,Cochrane,Web of Science,China Biomedical Literature Database,CNKI,Wanfang Database and VIP Science and Technology Journal Database from the establishment of the database to February 2022 was searched by computer and the selected literature was evaluated according to inclusion and exclusion criteria.After extracting relevant data,systematic evaluation and Meta-analysis were performed on the total effective rate,blood lipids,amylase,duration of abdominal pain relief,length of hospital stay and adverse reactions by RevMan 5.4 software.Results:A total of 8 studies were included,with a total of 637 cases,including 320 cases in the TCM treatment group and 317 cases in the control group.The results of Meta-analysis showed that the total effective rate in the TCM treatment group was better than the control group(OR=3.63,95%CI:2.10~6.3,P<0.01).The reduction level of triglycerides in the TCM treatment group was better than that in the control group(MD=–1.38,95%CI:–2.60~–0.16,P=0.03).The decreased level of amylase in the TCM treatment group was better than that in the control group(MD=–7.61,95%CI:–11.05~–4.16,P<0.01).The length of hospital stay was significantly shortened(MD=–1.20,95%CI:–1.70~–0.69,P<0.01),and no adverse drug reactions were reported.After excluding individual studies from the above Meta-analysis results,the conclusions did not change,indicating that the results were stable to a certain extent.The funnel plot was used to test the publication bias of the outcome index of total efficiency,and the results showed that the left and right distribution were not completely symmetric,suggesting that there might be publication bias in the results.Conclusion:Early application of TCM prescription can improve the clinical efficacy of hypertriglyceridemia acute pancreatitis,relieve abdominal pain,reduce blood lipid and amylase levels,shorten hospital stay,and it shows no adverse drug reactions.