运用网状Meta分析对不同口服中成药联合常规西医治疗胃食管反流病(GERD)的疗效和安全性进行评价。检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Cochrane Library、EMbase、Web of Science数据库，从建库至2023年9月收录的口服中成药联合常规西医治疗GERD的随机对照试验(RCT)，运用Cochrane风险偏倚评估工具对纳入文献进行质量评价，采用RevMan 5。4、Strata 16软件进行数据分析。最终纳入47篇RCTs，包含健胃愈疡片、气滞胃痛颗粒、达立通颗粒、六味安消胶囊、康复新液、胃苏颗粒、枳术宽中胶囊、小柴胡颗粒、逍遥丸、胆胃康胶囊共10种口服中成药。网状Meta分析显示，①临床症状有效率方面，累计概率排名曲线下面积(surface under the cumulative ran-king curve，SUCRA)排序第1的干预措施为达立通颗粒+常规西医;②内镜下有效率方面，SUCRA排序第1的干预措施为六味安消胶囊+常规西医;③升高血清胃泌素水平方面，SUCRA排序第1的干预措施为胃苏颗粒+常规西医;④升高血浆胃动素水平方面，SUCRA排序第1的干预措施为逍遥丸+常规西医。在症状积分、生存质量、复发率方面，由于各研究间异质性较大，仅做描述性分析，但各研究均报道了中成药联合常规西医对结局指标的改善优于常规西医，差异均具有统计学意义。不良反应方面，中成药联合常规西医与单用常规西医相比差异无统计学意义。通过聚类分析可知，达立通颗粒+常规西医、胆胃康胶囊+常规西医、气滞胃痛颗粒+常规西医、康复新液+常规西医、六味安消胶囊+常规西医综合疗效较突出，可同时改善临床症状和内镜下炎症。结果表明，口服中成药联合常规西医治疗GERD能够提高综合疗效，改善临床症状，调节胃肠动力。但由于纳入文献样本量及质量等限制，结论有待更多大样本、高质量的研究加以验证。
Network Meta-analysis of oral Chinese patent medicine combined with conventional western medicine in treatment of gastro-esophageal reflux disease
The effectiveness and safety of various oral Chinese patent medicines combined with conventional western medicine in treatment of gastro-esophageal reflux disease(GERD)were evaluated using network Meta-analysis.CNKI,Wanfang,VIP,SinoMed,PubMed,Cochrane Library,EMbase,and Web of Science were searched for randomized controlled trial(RCT)of oral Chinese patent medicines combined with conventional western medicine in treatment of GERD from inception to September 2023.The quality of the in-cluded studies was assessed using the Cochrane risk-of-bias tool,and data analysis was conducted using RevMan 5.4 and Stata 16 soft-ware.Forty-seven RCTs were included,involving 10 oral Chinese patent medicines,including Jianwei Yuyang Tablets,Qizhi Weitong Granules,Dalitong Granules,Liuwei Anxiao Capsules,Kangfuxin Liquid,Weisu Granules,Zhizhu Kuanzhong Capsules,Xiaochaihu Granules,Xiaoyao Pills,and Danweikang Capsules.Network Meta-analysis showed that:①in terms of effective rate of clinical symp-toms,intervention measure ranked first by SUCRA was Dalitong Granules+conventional western medicine.②In terms of endoscopic effective rate,intervention measure ranked first by SUCRA was Liuwei Anxiao Capsules+conventional western medicine.③In terms of increasing serum gastrin levels,intervention measure ranked first by SUCRA was Weisu Granules+conventional western medicine.④In terms of increasing plasma motilin level,intervention measure ranked first by SUCRA was Xiaoyao Pills+conventional western medicine.In terms of symptom scores,quality of life and recurrence rate,only descriptive analyses were performed due to the heteroge-neity of the studies,but all studies reported that oral Chinese patent medicines combined with conventional western medicine improved the outcome indicators better than conventional western medicine alone,and the differences were statistically significant.In terms of ad-verse reactions,there was no significant difference between oral Chinese patent medicine combined with conventional western medicine and conventional western medicine alone.Through cluster analysis,it was found that the comprehensive efficacy of Dalitong Granules+conventional western medicine,Danweikang Capsules+conventional western medicine,Qizhi Weitong Granules+conventional western medicine,Kangfuxin Liquid+conventional western medicine,and Liuwei Anxiao Capsules+conventional western medicine were more prominent,and could improve clinical symptoms and endoscopic inflammation at the same time.The results indicated that oral Chinese patent medicines combined with conventional western medicine in treatment of GERD could improve comprehensive efficacy,alleviate clinical symptoms,and regulate gastrointestinal motility.However,due to limitations such as sample size and quality of the included literature,the conclusions need to be further verified by more large-sample,high-quality studies.
Chinese patent medicinegastro-esophageal reflux disease(GERD)network Meta-analysis
NETL
NSTL
万方数据
