7种中药对比质子泵抑制剂治疗反流性食管炎疗效的网状Meta分析

Network Meta-analysis on Efficacy Comparison of Seven Kinds of Traditional Chinese Medicines and Proton Pump Inhibitors in the Treatment of Reflux Esophagitis

目的:基于网状Meta分析方法,系统评价7种中药(半夏厚朴汤、通降合剂、四逆散、小柴胡汤、旋覆代赭汤、气滞胃痛颗粒、半夏泻心汤)对比质子泵抑制剂(PPI)治疗反流性食管炎的临床疗效。方法:对中国知网、中国生物医学文献数据库、万方数据库、维普数据库、the Cochrane Library、Embase、PubMed等数据库进行检索,收集7种中药单纯使用或联合PPI治疗反流性食管炎的随机对照试验,检索时限均为2015年1月1日至2024年7月5日。对文献进行筛选、资料提取和质量评价,通过Stata 16.0软件进行Meta网状分析。结果:最终纳入39篇文献,共3342例反流性食管炎患者,涉及10种干预措施。网状Meta分析结果显示,与单纯使用PPI相比,在提高临床总有效率方面,通降合剂+PPI效果最佳;在提高胃镜有效率方面,半夏泻心汤+PPI效果最佳;在降低复发率方面,累积概率排序居前3位的分别为半夏泻心汤+PPI>四逆散+PPI>小柴胡汤+PPI;在降低反酸症状积分方面,累积概率排序居前3位的分别为通降合剂+PPI>四逆散+PPI>半夏泻心汤;在提高胃动素水平方面,累积概率排序居前3位的分别为半夏泻心汤+PPI>四逆散+PPI>通降合剂+PPI;在提高胃泌素水平方面,累积概率排序居前3位的分别为通降合剂+PPI>四逆散+PPI>气滞胃痛颗粒+PPI;在减少不良反应发生方面,7种中药均具有良好的安全性。结论:通降合剂+PPI在提高反流性食管炎患者的临床有效率、提高胃泌素水平、降低反酸症状积分方面效果较好,半夏泻心汤+PPI在提高胃镜有效率、提高胃动素水平、降低复发率、降低用药风险方面效果较好,但因目前纳入研究的数量和质量限制,上述结论有待进一步验证。

OBJECTIVE:To systematically evaluate clinical efficacy of seven kinds of traditional Chinese medicines(Banxia Houpo decoction,Tongjiang mixture,Sini powder,Xiaochaihu decoction,Xuanfu Daizhe decoction,Qizhi Weitong granule,and Banxia Xiexin decoction)compared with proton pump inhibitors(PPI)in the treatment of reflux esophagitis by network Meta-analysis.METHODS:CNKI,CBM,Wanfang Data,VIP,the Cochrane Library,Embase and PubMed was retrieved to collect the randomized controlled trials of seven kinds of traditional Chinese medicines(alone or in combination with PPI)in the treatment of reflux esophagitis.The retrieval time was from Jan.1st,2015,to Jul.5th,2024.Literature screening,data extraction and quality evaluation were carried out.Stata 16.0 software was used for network Meta-analysis.RESULTS:A total of 39 studies with 3342 patients with reflux esophagitis and 10 interventions were ultimately included.Network Meta-analysis showed that compared with PPI monotherapy,Tongjiang mixture+PPI had the optimized effect in improving the total clinical effectiverate.In terms of improving the efficiency of gastroscopy,Banxia Xiexin decoction+PPI had the best effect.In terms of reducing recurrence rate,the top 3 cumulative probabilities were Banxia Xiexin decoction+PPI>Sini powder+PPI>Xiaochaihu decoction+PPI.In terms of reducing the score of acid reflux symptoms,the top 3 cumulative probability were Tongjiang mixture+PPI>Sini powder+PPI>Banxia Xiexin decoction.In terms of increasing gastric motility,the top 3 cumulative probabilities were Banxia Xiexin decoction+PPI>Sini powder+PPI>Tongjiang mixture+PPI.In terms of the increasing the gastrin level,the top 3 cumulative probabilities were Tongjiang mixture+PPI>Sini powder+PPI>Qizhi Weitong granule+PPI.In terms of reducing the occurrence of adverse drug reactions,the seven kinds of traditional Chinese medicines had higher safety.CONCLUSIONS:Tongjiang mixture+PPI is more effective than other traditional Chinese medicines in improving clinical efficiency,increasing gastrin level,and reducing score of acid reflux symptoms,and Banxia Xiexin decoction+PPI is more effective than other traditional Chinese medicines in improving gastroscopy efficiency,increasing gastric motility,and decreasing recurrence rate and incidence of adverse drug reactions.However,in light of the current limitations in the quantity and quality of the included studies,it is necessary to perform further validation of the above conclusions.