文献类型：期刊文献

中文题名：中药灌肠联合西医常规疗法治疗重症急性胰腺炎临床疗效的Meta分析

英文题名：Meta-analysis on clinical efficacy of traditional Chinese medicine enema combined with western routine therapy in treatment of severe acute pancreatitis

作者：杨丹[1,2];魏莉莉[3,4];孙银凤[1,2];汪湛东[1,2];汪永锋[1,2];杨克虎[3,4]

第一作者：杨丹

机构：[1]甘肃中医药大学,甘肃兰州730000;[2]甘肃省实验动物行业技术中心,甘肃兰州730000;[3]兰州大学循证医学中心,甘肃兰州730000;[4]甘肃省循证医学与临床转化重点实验室,甘肃兰州730000

第一机构：甘肃中医药大学

年份：2022

卷号：29

期号：2

起止页码：177

中文期刊名：中国中西医结合急救杂志

外文期刊名：Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

收录：CSTPCD;;北大核心:【北大核心2020】；CSCD:【CSCD2021_2022】；

基金：国家自然科学基金(81760828);甘肃省中医药管理局科研课题(GZK-2019-26);甘肃省自然科学基金(20JR5RA186)。

语种：中文

中文关键词：重症急性胰腺炎;中药灌肠;随机对照实验;Meta分析

外文关键词：Severe acute pancreatitis;Traditional Chinese medicine enema;Randomized controlled trial;Meta-analysis

摘要：目的系统评价中药灌肠联合西医常规疗法治疗重症急性胰腺炎(SAP)的疗效及安全性,为临床治疗SAP提供循证参考。方法应用计算机检索中国知网(CNKI)、维普、万方数据库、中国生物医学文献服务系统(SinMed)、美国国立医学图书馆PubMed数据库、科学网(Web of Science)、Cochrane图书馆数据库、荷兰医学文摘Embase数据库中公开发表的有关中药灌肠联合西医常规疗法治疗SAP临床疗效的随机对照试验(RCT)。对照组给予西医常规治疗;试验组在西医常规治疗基础上给予中药灌肠。检索词包括:“重症急性胰腺炎”或“急性重症胰腺炎”,“灌肠”,检索时限为建库至2022年2月9日。结局指标:总有效率、血清淀粉酶、白细胞计数(WBC)恢复时间、腹痛缓解时间、白细胞介素-6(IL-6)水平。由2名评价者根据纳入和排除标准独立筛选文献,提取数据,评价纳入研究偏倚后,应用RveMan 5.3软件进行Meta分析;绘制漏斗图分析总有效率相关文献的发表偏倚。结果最终纳入12篇RCT,总病例数883例,试验组439例,对照组444例。Meta分析结果显示,与对照组比较,中药灌肠联合西医常规疗法试验组能明显提高总有效率〔相对危险度(RR)=1.31,95%可信区间(95%CI)为1.22~1.41,P<0.00001〕,降低血清淀粉酶〔均数差(MD)=-85.75,95%CI为-116.59~-54.92,P<0.00001〕和IL-6水平〔标准化均数差(SMD)=-2.86,95%CI为-3.99~-1.74,P<0.00001〕,缩短WBC恢复时间(MD=-2.45,95%CI为-3.59~-1.31,P<0.0001)和腹痛缓解时间(MD=-1.62,95%CI为-2.36~-0.87,P<0.0001)。基于总有效率相关文献绘制漏斗图显示,纳入文献散点分布不对称,提示存在发表偏倚。结论在西医常规治疗基础上加用中药灌肠治疗SAP,可明显缓解患者临床症状并降低炎症因子水平。但纳入文献质量偏低,需大量高质量的RCT进一步验证。
Objective To systematically evaluate the efficacy and safety of traditional Chinese medicine(TCM)enema combined with western routine therapy in the treatment of severe acute pancreatitis(SAP),so as to provide evidence-based reference for clinical treatment of SAP.Methods The published literatures in China National Knowledge Internet(CNKI),VIP,databases of Wanfang,SinMed,PubMed,Web of Science,Cochrane Library and Embase were searched by computer for the clinical efficacy of randomized controlled trial(RCT)related to the traditional Chinese medicine enema combined with western routine therapy in the treatment of SAP.The control group was given routine treatment of western medicine,and the experimental group was given traditional Chinese medicine enema on the basis of western routine treatment.The key words in Chinese for retrieval were translated into following English terms:severe acute pancreatitis or acute severe pancreatitis,enema;the search time was from the establishment of journals and databases to February 9,2022.Total effective rate,the serum amylase and recovery times of white blood cell count(WBC),remission time of abdominal pain and interleukin-6(IL-6)level were studied as indicators of outcomes.The literature screening,data extraction and inclusion bias evaluation were independently conducted by 2 evaluators according to the inclusion and exclusion criteria.Then,RevMan 5.3 was used for Meta-analysis.Funnel plot was drawn to analyze the publication bias of the literature related to the total effective rate.Results Finally 883 patients were enrolled in 12 RCT,including 439 cases in the experimental group and 444 cases in the control group.Meta-analysis results showed that compared with the control group,the experimental group of traditional Chinese medicine enema combined with western routine therapy could significantly improve the total effective rate[relative risk(RR)=1.31,95%confidence interval(95%CI)was 1.22-1.41,P<0.00001],decrease serum amylase levels[mean difference(MD)=-85.75,95%CI was-116.59 to-54.92,P<0.00001]and IL-6 levels[standardized mean difference(SMD)=-2.86,95%CI was-3.99 to-1.74,P<0.00001],and shorten the recovery time of WBC(MD=-2.45,95%CI was-3.59 to-1.31,P<0.0001)and the remission time of abdominal pain(MD=-1.62,95%CI was-2.36 to-0.87,P<0.0001).The funnel plot based on the literature related to the total effective rate showed that the scattered points of the included literature were asymmetrically distributed,which suggested existence of publication bias.Conclusions Traditional Chinese medicine enema combined with western routine therapy in the treatment of SAP can significantly alleviate the clinical symptoms and reduce the level of inflammatory factors.However,due to the quality of the included literatures is low,the above conclusions needs to be further verified by a large number of high-quality RCT.