基于AMSTAR-2质量评价和GRADE分级的中医治疗胃食管反流病疗效的Meta分析再评价

目的通过AMSTAR-2及GRADE对中医治疗胃食管反流病的Meta分析文献进行质量评价及分级,以期为临床医师使用中医治疗胃食管反流病提供参考。方法系统检索中国知网、万方-中国学术期刊数据库、中文科技期刊数据库(维普)、中国生物医学文献数据库、PubMed、EMbase、Web of Science,建立纳入及排除标准,筛选采用中医治疗胃食管反流病的Meta分析文献,使用AMSTAR-2及GRADE进行方法学质量评价及证据分级。结果最终纳入18篇文献,对于反流性食管炎和胃食管反流病,单纯采用中医药或者联合西药其疗效均优于单纯采用西药治疗,且复发率均低于西药组。但通过AMSTAR-2质量评价发现仅1篇文献可信度为中,1篇文献可信度为低,其余16篇文献可信度为极低。GRADE分级发现有效率、胃镜下有效率、复发率、不良反应率评级为低级或极低级,主要原因是研究局限性大。结论中医治疗胃食管反流病具有一定优势,但方法学质量及证据分级较低,需谨慎看待本研究结果,未来临床医师需不断提高临床研究质量,提高中医临床循证证据。

连花清瘟制剂治疗病毒性疾病的Meta分析再评价

为了对连花清瘟制剂治疗流行性感冒、新型冠状病毒肺炎、手足口病等病毒性疾病的Meta分析再评价,得到更高等级的循证证据,检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国临床试验注册中心、PubMed、EMbase、Web of Science、Cochrane Library等数据库,收集连花清瘟制剂治疗病毒感染性疾病的Meta分析,检索时间均为建库至2022年4月1日。根据纳入、排除标准筛选及提取文献内容后,使用AMSTAR2量表评价纳入的Meta分析质量,使用GRADE系统评价各结局指标质量,并汇总连花清瘟制剂治疗病毒感染性疾病的疗效及安全性。在最终纳入的13篇Meta分析中,3篇AMSTAR2评分为低级,10篇为极低级。共得到75个结局指标,涉及流行性感冒、新型冠状病毒肺炎、手足口病,GRADE评分结果为高级证据5个(6.7%),中级证据18个(24.0%),低级证据25个(33.3%),极低级证据27个(36.0%)。结果显示,(1)在治疗流行性感冒方面,临床疗效显愈率连花清瘟制剂优于其他中成药和利巴韦林,而与奥司他韦差异无统计学意义;改善临床症状指标连花清瘟制剂优于其他中成药、奥司他韦与利巴韦林;病毒核酸转阴时间与转阴率连花清瘟制剂与奥司他韦或中西医抗流感常规治疗差异无统计学意义。(2)在治疗新型冠状病毒肺炎方面,连花清瘟制剂联合或不联合常规治疗在总有效率、主要症状消退率、次要症状消退率及主要症状消退时间均优于常规治疗,并在改善发热好转率、发热持续时间、发热消退时间、咳嗽消退率、咳嗽消退时间、乏力消退率、乏力消退时间、肌痛消退率、咯痰消退率、胸闷消退率等优于常规治疗;而在咽痛消退率、恶心消退率、腹泻消退率、食欲下降消退率、头痛消退率、呼吸困难消退率、气短消退率等方面,连花清瘟制剂与常规治疗差异无统计学意义;在胸部CT改善率、临床转重症率、治愈时间及住院时间方面,连花清瘟单用或联合常规治疗均优于常规治疗。(3)在治疗手足口病方面,连花清瘟颗粒在总有效率、平均退热时间、疱疹消退时间及病毒核酸转阴时间优于常规治疗。(4)安全性方面,连花清瘟制剂组不良反应发生率较低且均为轻症,可随停药痊愈。现有证据表明,连花清瘟制剂能减轻流行性感冒、新型冠状病毒肺炎及手足口病患者的临床症状,缩短住院时间并改善胸部CT指标,在治疗病毒感染性疾病时有一定疗效,并且安全性佳。但由于原始研究的质量偏低,仍需开展更多高质量的临床试验支持以上结论。

Meta-analysis on protective effect of electroacupuncture at “Nèiguān”(内关 PC 6) in rats with reperfusion injury induced myocardial ischemia

Objective To systematically evaluate the protection effect of electroacupuncture at ＂Neiguan＂（内关 PC 6） on myocardial damage by means of evidence-based medicine.Methods Databases were retrieved by computer,while dissertation compilations and conference proceedings were searched manually.Data were analyzed statistically by using RevMan5.2software.Results Twelve studies were enrolled.Compared with myocardial ischemia reperfusion injury model group,① the magnitude of ECG STⅡ segment elevation can be reduced by means of electroacupuncture at PC 6（WMD=-73.95,95%CI[-109.69,-38.20]） and the difference was statistically significant（P0.0001）;② the ATPase in myocardial cells can be increased by means of electroacupuncture at PC 6（SMD=2.28,95%Cl[1.50,3.07]） and the difference was statistically significant（P0.00001）;③ the release of cTnT can be reduced by means of electroacupuncture at PC 6（WMD=-2.69,95%CI[-3.16,-2.22]） and the difference was statistically significant（P0.00001）;④ the size of myocardial infarction can be reduced by means of electroacupuncture at PC 6（WMD=-17.99,95%Cl[-19.88,-16.09]） and the difference was statistically significant（P0.00001）;⑤ the release of CK can be reduced by means of electroacupuncture at PC 6（WMD=-0.44,95%CI[-0.61,-0.27]） and the difference was statistically significant（P0.00001）;⑥ the release of CK-MB can be reduced by means of electroacupuncture at PC 6（SMD=-2.85,95%CI[-4.46,-1.24]） and the difference was statistically significant（P0.001）;⑦ the release of LDH can be reduced by means of electroacupuncture at PC 6（SMD=-2.97,95%CI[-4.87,-1.07]） and the difference was statistically significant（P0.01）.Conclusion Based on the current experimental evidences,electroacupuncture at PC 6 has a higher protective effect on myocardium.