中药注射剂联合常规方案治疗黄疸型肝炎的网状Meta分析

Network Meta-Analysis of Traditional Chinese Medicine Injection Combined with Conventional Regimen in the Treatment of Jaundice Hepatitis

目的:基于网状Meta分析方法,比较不同中药注射剂联合常规方案治疗黄疸型肝炎的有效性与安全性。方法:检索中国知网、万方数据库、维普数据库、中国生物医学文献服务系统、PubMed、the Cochrane Library、Web of Science和Embase中自建库至2022年9月收录的中药注射剂联合常规方案治疗黄疸型肝炎的随机对照试验(对照组患者采用常规方案治疗,不含中药注射剂;观察组患者在对照组基础上加用中药注射剂)。由2名研究者独立筛选文献、提取资料后,采用Stata 14软件进行网状Meta分析,采用RStudio软件进行文献偏倚风险评价。结果:共纳入66项随机对照试验,包含6269例患者。观察组患者的干预措施为痰热清注射液、苦黄注射液、清开灵注射液、舒肝宁注射液、岩黄连注射液、茵栀黄注射液联合常规方案,对照组为常规方案。网状Meta分析结果显示,在改善临床总有效率方面,累积排序曲线下面积(SUCRA)排序为痰热清注射液(88.3%)>清开灵注射液(77.3%)>岩黄连注射液(60.3%)>舒肝宁注射液(52.4%)>苦黄注射液(42.1%)>茵栀黄注射液(29.6%);在降低总胆红素方面,SUCRA排序为清开灵注射液(78.3%)>茵栀黄注射液(64.5%)>苦黄注射液(61.0%)>痰热清注射液(59.1%)>舒肝宁注射液(44.2%)>岩黄连注射液(41.8%);在降低直接胆红素方面,SUCRA排序为舒肝宁注射液(95.3%)>苦黄注射液(61.5%)>痰热清注射液(35.0%)。结论:当前证据表明,纳入的6种中药注射剂联合常规方案治疗均可显著改善黄疸型肝炎患者的临床疗效。其中在改善总有效率方面,痰热清注射液联合常规方案疗效最佳;在降低总胆红素方面,清开灵注射液联合常规方案的效果较好;在降低直接胆红素方面,舒肝宁注射液联合常规方案的效果显著。但因干预措施不同及纳入研究质量或数量的局限性,该结论仍需更多高水平研究加以验证。

OBJCETIVE:To compare the efficacy and safety of different traditional Chinese medicine injection combined with conventional regimen in the treatment of jaundice hepatitis based on network Meta-analysis method.METHODS:CNKI,Wanfang Data,VIP,SinoMed,PubMed,the Cochrane Library,Web of Science and Embase were retrieved to collect the randomized controlled trials(RCT)of traditional Chinese medicine injection combined with conventional regimen in the treatment of jaundice hepatitis(the control group was treated with conventional regimen,without traditional Chinese medicine injection,while the observation group was given traditional Chinese medicine injection on the basis of control group)up to Sept.2022.Two researchers independently screened the literature and extracted the data.The network Meta-analysis was performed by using Stata 14 software,and the risk of literature bias was evaluated by using RStudio software.RESULTS:A total of 66 RCT were enrolled,including 6269 patients.The intervention measures in the observation group were Tanreqing injection,Kuhuang injection,Qingkailing injection,Shuganning injection,Yanhuanglian injection,Yinzhihuang injection combined with conventional regimen,and the control group received conventional regimen.Network Meta-analysis showed that,in terms of improving the total clinical effective rate,the surface under the cumulative ranking curve(SUCRA)was Tanreqing injection(88.3%)>Qingkailing injection(77.3%)>Yanhuanglian injection(60.3%)>Shuganning injection(52.4%)>Kuhuang injection(42.1%)>Yinzhihuang injection(29.6%).In terms of improving the total clinical effective rate,the order of SUCRA was Qingkailing injection(78.3%)>Yinzhihuang injection(64.5%)>Kuhuang injection(61.0%)>Tanreqing injection(59.1%)>Shuganning injection(44.2%)>Yanhuanglian injection(41.8%).In terms of reducing direct bilirubin,the order of SUCRA was Shuganning injection(95.3%)>Kuhuang injection(61.5%)>Tanreqing injection(35.0%).CONCLUSIONS:The current evidence shows that the 6 kinds of traditional Chinese medicine injections combined with conventional regimen can significantly improve the clinical efficacy of patients with icteric hepatitis.Tanreqing injection combined with conventional regimen is the best in improving the total effective rate.In terms of reducing total bilirubin,Qingkailing injection combined with conventional regimen has a better effect.In terms of reducing direct bilirubin,Shuganning injection combined with conventional regimen has more significant effect.However,due to the limitations of different interventions and quality or quantity of included studies,this conclusion still needs to be verified by more high-level studies.