中医药治疗腹泻型肠易激综合征的临床疗效及肠道菌群变化的Meta分析

Clinical efficacy and intestinal flora changes of traditional Chinese medicine in the treatment of diarrhea-predominant irritable bowel syndrome:a Meta-analysis

[目的]评价中医及中西医结合对腹泻型肠易激综合征(IBS-D)的临床疗效及肠道菌群变化情况.[方法]检索中国知网、万方、维普、PubMed、Web of Science、Elsevier等数据库中有关IBS-D的中药及中药、西药结合与西药治疗随机对照试验方面的文献,检索时间为建库至2022年5月,采用RevMan 5.4软件对提取的有效数据进行Meta分析.[结果]共纳入13篇文献,共计973例患者.Meta分析结果显示:试验组临床总有效率的相对危险度(RR)为1.26,95%CI为[1.17,1.35],Ρ<0.001,治愈率RR=1.66,95%CI[1.21,2.28],Ρ=0.002,均显著优于西药组;与对照组比较,试验组酵母菌(MD=-1.14,95%CI[-1.27,-1.00],Ρ<0.01)、大肠杆菌(SMD=-0.70,95%CI[-1.19,-0.22],Ρ=0.004)、肠球菌(SMD=-1.30,95%CI[-1.87,-0.74],Ρ<0.001)等致病菌水平均显著降低,乳酸杆菌(SMD=1.17,95%CI[0.97,1.36],Ρ<0.001)、双歧杆菌(SMD=1.14,95%CI[0.83,1.45],Ρ<0.001)等有益菌水平均显著升高.[结论]中医及中西医结合治疗IBS-D在临床总有效率、治愈率及改善肠道微生态方面均优于单纯使用西药治疗.

OBJECTIVE To evaluate the clinical efficacy of traditional Chinese medicine(TCM) and integrated Chinese and Western medicine on diarrhea-predominant irritable bowel syndrome(IBS-D) and the changes of intestinal flora.METHODS The literatures on IBS-D of randomized controlled trials in the treatment with Chinese medicine,integrated Chinese and Western medicine and Western medicine were searched from CNKI,Wanfang,VIP,PubMed,Web of Science,Elsevier and other databases.The retrieval period was from the establishment of the database to May 2022.RevMan 5.4 software was used to performed meta-analysis of the extracted valid data.RESULTS A total of 13 literatures were included,with 973 patients.Meta-analysis results showed:The relative risk(RR) of the total clinical effective rate of the experimental group was 1.26,95%CI was [1.17,1.35],Ρ0.001,and the RR of the cure rate was 1.66,95%CI was [1.21,2.28],Ρ=0.002,all of which were significantly better than that of the Western medicine group.Compared with the control group,the levels of pathogenic bacteria Saccharomycetes(MD=-1.14,95%CI[-1.27,-1.00],Ρ0.01),Escherichia coli(SMD=-0.70,95%CI[-1.19,-0.22],Ρ =0.004),Enterococcus(SMD=-1.30,95%CI[-1.87,-0.74],Ρ 0.001) were significantly reduced in the experimental group,and the levels of beneficial bacteria Lactobacillus(SMD=1.17,95%CI[0.97,1.36],Ρ 0.001) and Bifidobacterium(SMD=1.14,95%CI[0.83,1.45],Ρ 0.001) were significantly increased.CONCLUSION TCM and integrated Chinese and Western medicine in the treatment of IBS-D is superior to Western medicine alone in terms of total clinical effective rate,cure rate,and improvement of intestinal microecology.