中药联合熊去氧胆酸治疗原发性胆汁性胆管炎临床疗效Meta分析

目的:通过Meta分析评价中药联合熊去氧胆酸治疗原发性胆汁性胆管炎(PBC)的临床疗效。方法:应用计算机从Cochrane Library、Pub Med、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、万方医药期刊全文及学位论文数据库中,搜索中药联合熊去氧胆酸(UDCA)和单用UDCA治疗PBC的随机对照试验(RCT)文献,截止日期到2017年12月,对纳入文献进行资料提取和文献偏倚风险评估并采用RevMan5.3进行分析。结果:结果:共纳入6项RCT试验,共401例患者,其中治疗组201例,对照组200例。Meta分析显示中药联合UDCA治疗PBC患者24周后,在提高临床症状改善率[OR=5.99,95%CI(3.71,9.68),P<0.05]、降低肝功能指标ALP[MD=-27.10,95%CI(-31.99,-22.21),P<0.05]、GGT[MD=-17.69,95%CI(-23.67,-11.71),P<0.05]、ALT[MD=-16.85,95%CI(-21.18,-12.52),P<0.05]、AST[MD=-8.67,95%CI(-11.19,-6.16),P<0.05]、降低总胆红素TBil[MD=-10.43,95%CI(-14.34,-6.52),P<0.05]、降低总胆汁酸TBil[MD=-12.24,95%CI(-20.83,-3.65),P<0.05],均优于对照组,复发率两组无差异统计学意义[OR=0.56,95%CI(0.14,2.23),P=0.41]。结论:中药联合UDCA治疗PBC在24周内对改善临床症状以及肝功能指标优于单独使用熊去氧胆酸治疗,但受纳入的RCT研究样本量和质量的限制且存在不明确和高风险偏倚,上述结论需更高质量的研究再验证。

Efficacy of traditional Chinese medicine combined with ursodeoxycholicacid for primary biliary cirrhosis with meta-analysis

ObjectiveTo systematically evaluate efficacy of traditional Chinese medicine combined with ursodeoxycholic acid for primary biliary cirrhosis by meta-analysis.Methods:Wesearched the China national knowledge infrastructure(CNKI),Chinese scientific journals full-text database(VIP),Chinese biomedical literature Database(CBM),and collected the randomized controlled trial(RCT)which is the traditional Chinese medicine combined with ursodeoxycholic acid for primary biliary cirrhosis,and published in China before December 2,017.The literature bias risk assessment of included trials was assessed and the data were extracted,then using RevMan 5.3 software for Meta-analysis.Results:A total of 6 RCTs wereincluded,involving 401 patientswith 201 in the test group and 200 in the control group.The results ofmeta-analysis showed that:After24 weeks of treating PBC patientswith Chinese medicine combinedwith ursodeoxycholic acid,in improving the rate ofimprovement of clinicalsymptoms(OR=5.99,95%CI[3.71,9.68],P<0.05),reducing the biochemical indices of liverfunction included ALP(MD=-27.10,95%CI[-31.99,-22.21],P<0.05),GGT(MD=-17.69,95%CI[-23.67,-11.71],P<0.05),ALT(MD=-16.85,95%CI[-21.18,-12.52],P<0.05),AST(MD=-8.67,95%CI[-11.19-6.16],P<0.05),reducingg the totalbilirubin(MD=-10.43,95%CI[-14.34-6.52],P<0.05)andreducing the total biliary acid(MD=-12.24,95%CI[-20.83-3.65],P<0.05),above all in the test group were significantly improved compared with those inthe control group.There was no significant difference in relapserate between the two groups(OR=0.56,95%CI[0.14,2.23],P=0.41).Conclusion:Traditional Chinese medicine combined with ursodeoxycholic acid for primary biliary cirrhosis has obvious advantages over the use of ursodeoxycholic acid alone in improving clinical symptoms and liver function indexes within 24 weeks.