半夏白术天麻汤合泽泻汤治疗眩晕临床疗效的Meta分析与试验序贯分析

Meta-analysis and Sequential Analysis of the Clinical Efficacy of Banxia Baizhu Tianma Decoction Combined with Zexie Decoction in the Treatment of Vertigo

目的:系统评价半夏白术天麻汤合泽泻汤治疗眩晕的临床疗效。方法:通过中国知网(CNKI)、万方(WanFang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、EMbase、PubMed、Web of Science检索半夏白术天麻汤合泽泻汤治疗眩晕的随机对照试验,检索时限为建库至2022年4月30日。根据纳入与排除标准筛选文献,并进行数据提取,采用Corchane 5.1.0系统评价手册进行质量评价,提取的数据使用RevMan 5.4及Stata17分析。结果:共纳入10篇文献,共涉及924例病人,其中对照组457例,治疗组467例。Meta分析结果显示,治疗组总有效率高于对照组[OR=3.95,95%CI(2.63,5.93),P<0.00001],采用Stata软件中的Egger′s检验对总有效率进行发表偏倚分析,结果显示P=0.003。治疗组治疗后全血高切黏度[MD=-0.60,95%CI(-0.88,-0.32),P<0.0001]、全血低切黏度[MD=-2.45,95%CI(-2.73,-2.18),P<0.00001]低于对照组;治疗后中医症状头晕目眩评分[MD=-0.85,95%CI(-0.94,-0.76),P<0.00001]、头重如裹评分、胸闷评分[MD=-0.94,95%CI(-1.05,-0.82),P<0.00001]、呕吐评分[MD=-1.34,95%CI(-1.47,-1.20),P<0.00001]低于对照组。进一步采用试验序贯分析验证了Meta分析结果。结论:现有证据表明,半夏白术天麻汤合泽泻汤治疗眩晕较单纯西药治疗临床疗效更佳。

Objective:To evaluate the clinical efficacy of Banxia Baizhu Tianma Decoction combined with Zexie Decoction in the Treatment of Vertigo.Methods:The randomized controlled trials of Banxia Baizhu Tianma Decoction combined with Zexie Decoction in the treatment of vertigo were retrieved from CNKI,WanFang,VIP,SinoMed,EMbase,PubMed,and Web of Science.The retrieval time limit was from the establishment of the databases to April 30,2022.The literature was screened according to the inclusion and exclusion criteria and data were extracted for quality evaluation using the Corchane 5.1.0 system evaluation manual,and the extracted data were analyzed using RevMan 5.4.Results:A total of 10 studies were included,involving a sample size of 924 patients,with 457 in the control group and 467 in the treatment group.The results of meta-analysis showed that the total effective rate of the treatment group was higher than that of the control group(OR=3.95,95%CI 2.63-5.93,P<0.00001).The Egger test in Stata software was used to analyze the total effective rate for publication bias,yielding a result of P=0.003.After treatment,the whole blood high shear viscosity(MD=-0.60,95%CI-0.88--0.32,P<0.0001)and the whole blood low shear viscosity(MD=-2.45,95%CI-2.73--2.18,P<0.00001)in the treatment group were lower than those in control group.After treatment,the traditional Chinese medicine symptoms of dizziness and dizziness score(MD=-0.85,95%CI-0.94--0.76,P<0.00001),head heavy like wrapping score(MD=-0.91,95%CI-1.13--0.69,P<0.00001),chest tightness score(MD=-0.94,95%CI-1.05--0.82,P<0.00001),and vomiting score(MD=-1.34,95%CI-1.47--1.20,P<0.00001)in the treatment group were lower than those in the control group.Subgroup analysis showed a greater effect of sample size on head weight as wrap symptoms.Further experimental sequential analysis was used to validate the results of the meta-analysis.Conclusion:Available evidence indicates that the clinical efficacy of Banxia Baizhu Tianma Decoction combined with Zexie Decoction in the treatment of vertigo is better than that of western medicine alone.