7种中药方治疗肝胃不和型胃食管反流病的网状Meta分析

A Network Meta-analysis of Traditional Chinese Medicine Prescription for Gastroesophageal Reflux Disease

目的:采用网状Meta分析方法比较7种中药方治疗肝胃不和型胃食管反流病(GERD)的临床疗效。方法:计算机检索PubMed、The Cochrane Library(2018年1期)、CBM、中国知网、维普及万方数据库,检索时限从建库开始至2018年4月1日,检索有关中药方治疗肝胃不和型GERD的临床研究。在提取相关资料,评价文献质量后,采用Stata 13.0绘制网络图,采用review manager 5.3软件进行传统Meta分析,用Gemtc 14.3软件进行网状Meta分析。结果:纳入21项,共1667例GERD患者,涉及7种中药方。结果显示:①在总有效率方面,柴胡疏肝散、柴平汤、四逆散及四逆温胆汤高于PPI+促动力药及PPI,疏肝和胃降逆汤高于单纯使用PPI,但抗反流1号方及清降饮与PPI+促动力药相比无明显差异;柴平汤加减的总有效率高于疏肝和胃降逆汤及清降饮,而其余中药方两两比较差异无统计学意义。概率排序结果为:柴平汤>四逆温胆汤>柴胡疏肝散>四逆散>抗反流1号方>疏肝和胃降逆汤>PPI>PPI+促动力药>清降饮。②在复发率方面,柴胡疏肝散低于PPI及PPI+促动力药,疏肝和胃降逆汤低于PPI+促动力药,差异具有统计学意义;5种中药方的复发率之间两两比较无统计学意义。概率排序结果为:PPI+促动力药>清降饮与PPI>四逆温胆汤>疏肝和胃降逆汤>柴平汤>柴胡疏肝散。结论:综合考虑总有效率及复发率,柴平汤加减治疗肝胃不和型GERD的短期疗效最佳,柴胡疏肝散治疗肝胃不和型GERD的长期疗效最好。但由于本研究的局限性,上述结论需谨慎看待,需开展不同中药方直接比较的高质量、大样本、多中心研究进一步验证。

Objective:We made a network Meta-analysis to compare the clinical effects of traditional Chinese medicine(TCM)priscription on gastroesophageal reflux disease(GERD).Methods:We searched the EMbase,PubMed,the Cochrane Library(Issue 1,2018),CBM,CNKI,VIP and Wangfang databases to find out the clinical studies about TCM prescriptions for GERD.After screening and assessing the risk of bias,we used the Stata 13.0 software to make network plot,and used Review manager 5.3 to make the traditional Meta analysis,and then used Gemtc 14.3 software to make a network Meta analysis.Results:Twenty-one studies were included,including 1667 patients,involving 7 kinds of prescriptions.The results showed that:①As for the total effects,Chaihus Hugan Powder,Chaiping Decotion,Sini Powder and Sini Wendan Decotion were higher than that of using PPI and PPI combined prokinetics.The total effect of Shugan Hewei Jiangni Decotion was higher than PPI′s.However,those of anti-reflux I Prescription and Qingjiang Yin were similar to PPI′s and that of Chaiping Decotion was higher than those of Shugan hewei jiangni Decotion and Qingjiang Yin,while pairwise comparisons of the other TCM prescriptions were not significant.The probability ranking was Chaiping Decotion>Sini Wendan Decotion>Chaihu Shugan Powder>Sini Powder>Anti-reflux I Prescription>Shugan Hewei Jiangni Decotion>PPI>PPI+prokinetics>Qingjiang Yin.②As for the recurrence rate,that of the Shugan Hewei Jiangni Decotion was lower than that of PPI+prokinetics with significance.Pairwise comparisons of the recurrence rate in five kinds TCM prescriptions were not significant.The probability ranking was PPI+prokinetics>Qingjiang Yin and PPI>Sini Wendan Decotion>Shugan Hewei Jiangni Decotion>Chaiping Decotion>Chaihu Shugan Powder.Conclusion:In terms of the short-term effect of treating GERD of hepat-ogastric disharmony type,Chaiping Decotion was most probably to be the most effective intervention,while in terms of the long-term effect,Chaihu Shugan Powder seemingly to be the best choice.Because of the limitations in our study,the conclusion needed to be verified by more high-quality,large sample and multi-center studies comparing different Chinese medicine directly.