中医外治法治疗胃食管反流病系统评价再评价

External therapy of TCM for gastroesophageal reflux disease:an overview of systematic reviews

目的对中医外治法治疗胃食管反流病(GERD)的系统评价/meta分析进行再评价。方法检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(重庆维普)、中国生物医学文献数据库(CBM)、PubMed、Embase和Cochrane Library建库至2022年12月31日有关中医外治法治疗GERD的系统评价/meta分析。采用AMSTAR 2工具、PRISMA 2020报告规范、GRADE指南评价纳入文献的方法学质量、报告质量和证据质量,从发表年份、研究设计类型、方法学质量评分、报告学质量评分、同质性程度与发表偏倚风险评价6个维度进行多元评价。结果共纳入系统评价/meta分析9篇,其中1篇基于AMSTAR 2的方法学质量为低质量,8篇极低质量。GRADE指南证据质量分级结果显示,33个结局指标中,中级证据9个,低级证据21个,极低级证据3个。9篇文献PRISMA 2020报告学质量评分为16~24分,其中1篇报告相对完全,8篇有一定缺陷。多元评价的秩数平均分表明,2篇文献质量较高,1篇质量欠佳。结论中医外治法治疗GERD在提高治愈率、降低不良反应等方面,证据质量为中级,推荐临床使用。但目前中医外治法治疗GERD的系统评价/meta分析的方法学质量和报告质量均有待提高,建议证据使用者谨慎使用上述证据进行决策。

Objective To overview the systematic reviews/meta analysis of the treatment of external therapy of TCM for gastroesophageal reflux disease(GERD).Methods Systematic reviews/meta analysis of the treatment of external therapy of TCM for GERD were retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Embase and Cochrane Library databases from the establishment of the databases to 31st,December 2022.The AMSTAR 2 tool,PRISMA 2020 reporting specifications,and GRADE guidelines were used to evaluate the methodological quality,reporting quality,and evidence quality of the included literature.A multiple evaluation was performed in six dimensions:year of publication,type of study design,methodological quality score,reporting quality score,degree of homogeneity,and risk of publication bias evaluation.Results A total of 9 systematic reviews/meta analysis were included,of which 1 was of low quality methodological quality and 8 was of very low quality.GRADE guidelines evidence quality grading results showed 33 outcome indicators,9 of which were with moderate evidence,21 of which were with low evidence,and 3 of which were with very low evidence.9 articles had reporting quality scores ranging from 16 to 24,of which 1 report was relatively complete and 8 had some deficiencies.The rank mean scores of multiple evaluations indicated that 2 articles were of high quality and 1 article was of poor quality.Conclusions The quality of evidence for the treatment of external therapy of TCM for GERD is intermediate in terms of improving the cure rate and reducing adverse effects,and is recommended for clinical use.However,the methodological quality and reporting quality of the current systematic reviews/meta analysis of the treatment of external therapy of TCM for GERD need to be improved,and users of the evidence ought to use the above evidence with caution for decision making.