文献类型：期刊文献

中文题名：黄芪建中汤加减治疗脾胃虚寒型胃溃疡有效性与安全性的系统评价与Meta分析

英文题名：Systematic Review and Meta-analysis of the Efficacy and Safety of Modified Huangqi Jianzhong Decoction(黄英建中汤)in Treating Gastric Ulcer of Spleen and Stomach Deficiency-cold Type

作者：李博宽[1];李金田[1];李娟[1];张毅[1]

第一作者：李博宽

机构：[1]甘肃中医药大学,甘肃省兰州市730030

第一机构：甘肃中医药大学

年份：2020

卷号：61

期号：20

起止页码：1794

中文期刊名：中医杂志

外文期刊名：Journal of Traditional Chinese Medicine

收录：CSTPCD;;北大核心:【北大核心2017】；CSCD:【CSCD2019_2020】；

语种：中文

中文关键词：黄芪建中汤;三联疗法;胃溃疡;脾胃虚寒型;Meta分析

外文关键词：Huangqi Jianzhong Decoction(黄英建中汤);triple therapy;gastric ulcer;spleen and stomach deficiencycold type;meta analysis

摘要：目的系统评价黄芪建中汤加减治疗脾胃虚寒型胃溃疡的有效性与安全性。方法计算机检索中国知网、万方数据库、维普数据库、Pubmed和Cochrane Library发表的黄芪建中汤加减治疗胃溃疡脾胃虚寒型的随机对照试验,检索自建库日期至2019年10月1日。使用Cochrane手册评估研究的内容是否存在偏倚风险、应用GRADEprofiler 3.6.1软件对结果进行分级评价,使用Egger's检验研究超过10篇的结局是否有发表偏倚,并用RevMan 5.3软件对未好转率、溃疡面愈合情况、治愈率、总有效率、幽门螺杆菌(HP)清除率、复发率和不良反应发生率进行Meta分析。结果共纳入17篇文献,患者共1692例(黄芪建中汤加减组849例,西药三联疗法组843例)。Meta分析结果显示:与西药三联疗法组比较,黄芪建中汤加减组在胃溃疡的治愈率[RR=1.42,95%CI(1.27,1.59),P<0.01]、总有效率[RR=1.21,95%CI(1.17,1.27),P<0.01]、溃疡面愈合情况[MD=1.48,95%CI(1.24,1.72),P<0.01]方面疗效更显著,在胃溃疡的未好转率[RR=0.30,95%CI(0.21,0.42),P<0.01]、不良反应发生率[RR=0.27,95%CI(0.09,0.78),P=0.02]和复发率[RR=0.30,95%CI(0.21,0.43),P<0.01]方面更低;但在HP清除率[RR=0.93,95%CI(0.80,1.09),P=0.37]方面,黄芪建中汤加减组和西药三联疗法组差异无统计学意义。根据GRADE评价标准,未好转率、治愈率和总有效率3个结局指标证据为中等质量,复发率、HP清除率和溃疡面愈合情况3个结局指标证据为低质量,不良反应发生率的结局指标证据为极低质量。结论黄芪建中汤加减治疗脾胃虚寒型胃溃疡在治愈率、有效率、创面愈合情况方面优于西药三联疗法,且未好转率、不良反应发生率、复发率更低。
Objective To systematically evaluate the efficacy and safety of modified Huangqi Jianzhong Decoction(黄芪建中汤)in the treatment of gastric ulcer of spleen and stomach deficiency-cold type.Methods Randomized controlled trial of modifed Huangqi Jianzhong Decoction in the treatment of gastric ulcer was screened in WanFang database,Pubmed,VIP,CochraneLibrary and China knowledge Network(CNKI)from the date of establishment to October 1,2019.Cochrane manual was used to evaluate whether there were risks of bias,GRADEprofiler 3.6.1 software was used to grade the results,Egger's test was used to study whether there was publication bias in the results of more than 10 articles,and RevMan5.3 software was used to analyze the unrecovered rate,ulcer healing condition,curative rate,total effective rate,Helicobacter pylori(HP)clearance rate,recurrence rate and the incidence of adverse reactions for meta-analysis.Results A total of 17 related research literature were enrolled,including 1692 patients(Modified Huangqi Jianzhong Decoction group with 849 cases,western medicine triple therapy group with 843 cases).The results of meta-analysis showed that compared with the routine western medicine triple therapy group,modified Huangqi Jianzhong Decoction group has more remarkable effect in the clinical curative rate in gastric ulcer[RR=1.42,95%CI(1.27,1.59),P<0.01],the total effective rate of gastric ulcer(cured+markedly effective+effective)rate[RR=1.21,95%CI(1.17,1.27),P<0.01],the healing of the ulcer surface[MD=1.48,95%CI(1.24,1.72),P<0.01],the unrecovered rate of gastric ulcer[RR=0.30,95%CI(0.21,0.42),P<0.01],the incidence of adverse reactions[RR=0.27,95%CI(0.09,0.78),P=0.02]and the recurrence rate[RR=0.30,95%CI(0.21,0.43),P<0.01]are lower.However,in terms of HP clearance rate[RR=0.93,95%CI(0.80,1.09),P=0.37],there was no statistically significant difference between the modified Huangqi Jianzhong Decoction group and the western medicine triple therapy group.According to GRADE evaluation criteria,the evidence of three outcome indicators including unrecovered rate,curative rate,and total effective rate were of medium quality,evidence of three outcome indicators including recurrence rate,HP clearance rate and ulcer surface healing were of low quality.Outcome indicator evidence of adverse reaction rate is of very low quality.Conclusion Modified Huangqi Jianzhong Decoction in the treatment of gastric ulcer of spleen and stomach deficiency-cold type is better than that of routine triple therapy of western medicine in curative rate,effective rate and ulcer healing condition,and the unrecovered rate,the incidence of adverse reactions,and the recurrence rate are lower.