以乌梅丸为主的干预措施治疗腹泻型肠易激综合征的Meta分析
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摘要
目的:探讨以乌梅丸为主的干预措施治疗腹泻型肠易激综合征(IBS-D)的有效性和安全性,为临床推广提供科学依据。方法:通过文献筛选纳入以乌梅丸为主的干预措施治疗IBS-D的随机对照临床研究,用Cochrane评价方法对文献进行偏倚风险评估;并收集文献的发表时间、研究者、样本量、研究对象性别、干预措施、疗程、结局指标,利用Revman 5.3软件对数据进行Meta分析。结果:共纳入10篇符合要求的文献,Meta分析结果显示:与不含乌梅丸的干预措施相比,含乌梅丸的干预措施治疗IBS-D的综合疗效合并效应量RR=1.19,95%CI[1.11,1.26],差别具有统计学意义(P <0.05)。与单用西药的干预措施相比,含乌梅丸的干预措施的综合疗效的合并效应量RR=1.18,95%CI[1.10,1.26]差别具有统计学意义(P <0.05)。异质性检验没有统计学差异。所有研究的乌梅丸试验组均未报告有不良反应。结论:以乌梅丸为主的干预措施治疗IBS-D有更好的临床疗效,安全性较好,适合临床推广使用。
Objective: To discuss the effectiveness and safety of intervention measures based on Plum Pills in the treatment of diarrhea type irritable bowel syndrome(IBS-D). Method: Randomized controlled trials(RCTs) about Plum Pill and its modified prescriptions in treating IBS-D were included. Their bias risk was assessed by the Cochrane scale.The published time, researchers, sample size, subjects' gender, interventions, period of treatment, and outcome indicators of the included literatures were collected. A Meta-analysis was made of the data using Revman 5.3 software.Result: A total of 10 RCTs were included. The results of Meta-analysis showed that compared with the control group, the combined RR of clinical efficacy in the Plum Pill combined group was 1. 19,95% CI(1.11,1.26),with statistical significance(P < 0.05).The results of subgroup analysis showed that compared with the simple western medicine control group, the combined RR of clinical efficacy in the Plum Pill combined group was 1.18,95% CI(1.10,1.26),with statistical significance(P < 0.05).The heterogeneity test didn't show statistical significance. All studies of Plum Pill group had not been reported adverse reactions. Conclusion: Compared with the control group, Plum Pill had a better clinical efficacy and good safety, so it is suitable for clinical use.
Objective: To discuss the effectiveness and safety of intervention measures based on Plum Pills in the treatment of diarrhea type irritable bowel syndrome(IBS-D). Method: Randomized controlled trials(RCTs) about Plum Pill and its modified prescriptions in treating IBS-D were included. Their bias risk was assessed by the Cochrane scale.The published time, researchers, sample size, subjects' gender, interventions, period of treatment, and outcome indicators of the included literatures were collected. A Meta-analysis was made of the data using Revman 5.3 software.Result: A total of 10 RCTs were included. The results of Meta-analysis showed that compared with the control group, the combined RR of clinical efficacy in the Plum Pill combined group was 1. 19,95% CI(1.11,1.26),with statistical significance(P < 0.05).The results of subgroup analysis showed that compared with the simple western medicine control group, the combined RR of clinical efficacy in the Plum Pill combined group was 1.18,95% CI(1.10,1.26),with statistical significance(P < 0.05).The heterogeneity test didn't show statistical significance. All studies of Plum Pill group had not been reported adverse reactions. Conclusion: Compared with the control group, Plum Pill had a better clinical efficacy and good safety, so it is suitable for clinical use.
引文
1胡静怡,杜斌.中医药治疗腹泻型肠易激综合征机制的研究进展.中国临床研究,2016,29(9):1263-1265,1268.
2纪慧萍,查安生.腹泻型肠易激综合征中医药研究概况.中医药临床,2016,28(11):1511-1513.
3苏冬梅,张声生,刘建平,等.中医药治疗腹泻型肠易激综合征的系统评价研究.中华中医药杂志,2009,24(4):532-535.
4 Zhu J J,Liu S,Su X L,et a1.Efficacy of Chinese Herbal Medicine for Diarrhea-Predominant Irritable Bowel Syndrome:A meta-analysis of randomized,double-blind,placebo-controlled trials.Evid Based Complement Alternat Med,2016,2016(1):4071260.
5黄大祥,白洁.乌梅丸合逍遥散治疗肠易激综合征腹泻型39例.中华实用中西医杂志,2005,18(18):968.
6韦艳碧.乌梅丸治疗腹泻型肠易激综合征.辽宁中医药大学学报,2009,11(9):80-81.
7岑柏春.加味乌梅丸治疗腹泻型肠易激综合征临床观察.湖北中医杂志,2011,33(12):33.
8李娜.新加乌梅丸治疗腹泻型肠易激综合征29例临床观察.河北中医,2014,36(1):52-53.
9倪树文,孙金蝉.乌梅丸治疗寒热错杂腹泻型肠易激综合征的临床研究.中医药报,2014,13(2):53-55,58.
10骆洁恒,肖波,郑春霞.乌梅丸联合中药敷贴治疗寒热错杂型腹泻型肠易激综合征.湖北中医杂志,2016,38(4):32-34.
11黄群,冷玉杰.乌梅丸煎剂对腹泻型肠易激综合征疗效影响及中药学监护意义.辽宁中医药大学学报,2016,18(9):78-81.
12王小辉,黄慧芝,葛来安,等.乌梅丸加味联合穴位贴敷治疗腹泻型肠易激综合征疗效观察.亚太传统医药,2016,12(14):150-151.
13涂云,许素瑜,黄秀杰,等.乌梅丸加减治疗腹泻型肠易激综合征60例.河南中医,2017,37(5):776-778.
14马军,韩棉梅,宋雨鸿.乌梅丸联合中药贴敷治疗寒热错杂型肠易激综合征疗效及对Th1/Th2细胞因子的影响.陕西中医,2017,38(2):156-158.
15 Drossman D A,Corazziari E,Jalley N J,et al.Functional gastrointestinal disorders:RomeⅡ.Mclean,Virginia:Dgnon and Associates,2000:360-382.
16 Drossman D A.The functional gastrointestinal disorders and the Rome III process.Gastroenterology,2006,130(5):1377-1390.
17郑筱萸.中药新药临床研究指导原则(试行).北京:中国医药科技出版社,2002:139-143.
18孙传兴.临床疾病诊断依据治愈好转标准.北京:人民军医出版社,2002:169.
19葛均波,徐永健.内科学(第8版).北京:人民卫生出版社,2013:399.
20张磊,宋军.肠易激综合征的研究新进展.临床消化病杂志,2014,26(3):137-138.
21 Tanaka Y,Kanazawa M,Fukudo S,et al.Biopsychosocial model of irritable bowel sydrome.J Neurogastroenterol Motil.2011,17(2):131-139.
22端木薇佳,袁建辉,龚枚,等.腹泻型肠易激综合征中医及中西医结合治疗概述.实用中医药杂志,2012,28(9):806-807.
23陶琳,张声生,肖旸,等.健脾疏肝法对腹泻型肠易激综合征患者生活质量的影响.北京中医药,2012,31(6):437-440.
24施晓萍,顾勤.腹泻型肠易激综合征肝郁脾虚证的研究进展.环球中医药,2013,6(12):948-951.
25尚精娟,唐蓉珠,徐晖,等.疏肝饮对内脏高敏感性大鼠结肠及DRG中SP和CGRP表达的影响.辽宁中医杂志,2014,41(6):1287-1290.
26李蒙,吕宾,鉏莉,等.痛泻要方对内脏高敏感大鼠肠道肥大细胞及细胞因子表达的影响.中国中西医结合杂志,2014,34(9):1130-1134.
27白雪琴,周正华.疏肝健脾法治疗腹泻型肠易激综合征研究进展.江西中医药,2015,46(385):75-77.
28马冬颖,彭莉莉.四逆散合痛泻要方加味治疗腹泻型肠易激综合征疗效观察.山西中医,2016,32(1):16-17.
29杨梅,柳华,代二庆.乌梅丸治疗消化系统疾病应用概述.天津中医药大学学报,2015,34(2):125-128.
30陆为民,徐丹华,周晓波,等.徐景藩教授论治腹泻型肠易激综合征的经验.江苏中医药,2012,44(11):1-3.
31刘渡舟,傅士垣.伤寒论诠解.天津:科学技术出版社,1983:183.
32 Liu L,Yuan S F,Sun Y,et al.The possible mechanisms of Fructus Mume pill in the treatment of colitis induced by 2,4,6-trinitrobenzene sulfonic acid in rats.Journal of Ethnopharmcology,2009,126(3):557-564.
33王佳林.乌梅丸治疗溃疡性结肠炎的疗效观察及对血清IL-4和IL-8水平的影响.海南医学院学报,2014,20(1):80-82.
34杨宪章,刘广霞.穴位贴敷疗法与贴敷工具.上海针灸杂志,2011,30(5):350.
2纪慧萍,查安生.腹泻型肠易激综合征中医药研究概况.中医药临床,2016,28(11):1511-1513.
3苏冬梅,张声生,刘建平,等.中医药治疗腹泻型肠易激综合征的系统评价研究.中华中医药杂志,2009,24(4):532-535.
4 Zhu J J,Liu S,Su X L,et a1.Efficacy of Chinese Herbal Medicine for Diarrhea-Predominant Irritable Bowel Syndrome:A meta-analysis of randomized,double-blind,placebo-controlled trials.Evid Based Complement Alternat Med,2016,2016(1):4071260.
5黄大祥,白洁.乌梅丸合逍遥散治疗肠易激综合征腹泻型39例.中华实用中西医杂志,2005,18(18):968.
6韦艳碧.乌梅丸治疗腹泻型肠易激综合征.辽宁中医药大学学报,2009,11(9):80-81.
7岑柏春.加味乌梅丸治疗腹泻型肠易激综合征临床观察.湖北中医杂志,2011,33(12):33.
8李娜.新加乌梅丸治疗腹泻型肠易激综合征29例临床观察.河北中医,2014,36(1):52-53.
9倪树文,孙金蝉.乌梅丸治疗寒热错杂腹泻型肠易激综合征的临床研究.中医药报,2014,13(2):53-55,58.
10骆洁恒,肖波,郑春霞.乌梅丸联合中药敷贴治疗寒热错杂型腹泻型肠易激综合征.湖北中医杂志,2016,38(4):32-34.
11黄群,冷玉杰.乌梅丸煎剂对腹泻型肠易激综合征疗效影响及中药学监护意义.辽宁中医药大学学报,2016,18(9):78-81.
12王小辉,黄慧芝,葛来安,等.乌梅丸加味联合穴位贴敷治疗腹泻型肠易激综合征疗效观察.亚太传统医药,2016,12(14):150-151.
13涂云,许素瑜,黄秀杰,等.乌梅丸加减治疗腹泻型肠易激综合征60例.河南中医,2017,37(5):776-778.
14马军,韩棉梅,宋雨鸿.乌梅丸联合中药贴敷治疗寒热错杂型肠易激综合征疗效及对Th1/Th2细胞因子的影响.陕西中医,2017,38(2):156-158.
15 Drossman D A,Corazziari E,Jalley N J,et al.Functional gastrointestinal disorders:RomeⅡ.Mclean,Virginia:Dgnon and Associates,2000:360-382.
16 Drossman D A.The functional gastrointestinal disorders and the Rome III process.Gastroenterology,2006,130(5):1377-1390.
17郑筱萸.中药新药临床研究指导原则(试行).北京:中国医药科技出版社,2002:139-143.
18孙传兴.临床疾病诊断依据治愈好转标准.北京:人民军医出版社,2002:169.
19葛均波,徐永健.内科学(第8版).北京:人民卫生出版社,2013:399.
20张磊,宋军.肠易激综合征的研究新进展.临床消化病杂志,2014,26(3):137-138.
21 Tanaka Y,Kanazawa M,Fukudo S,et al.Biopsychosocial model of irritable bowel sydrome.J Neurogastroenterol Motil.2011,17(2):131-139.
22端木薇佳,袁建辉,龚枚,等.腹泻型肠易激综合征中医及中西医结合治疗概述.实用中医药杂志,2012,28(9):806-807.
23陶琳,张声生,肖旸,等.健脾疏肝法对腹泻型肠易激综合征患者生活质量的影响.北京中医药,2012,31(6):437-440.
24施晓萍,顾勤.腹泻型肠易激综合征肝郁脾虚证的研究进展.环球中医药,2013,6(12):948-951.
25尚精娟,唐蓉珠,徐晖,等.疏肝饮对内脏高敏感性大鼠结肠及DRG中SP和CGRP表达的影响.辽宁中医杂志,2014,41(6):1287-1290.
26李蒙,吕宾,鉏莉,等.痛泻要方对内脏高敏感大鼠肠道肥大细胞及细胞因子表达的影响.中国中西医结合杂志,2014,34(9):1130-1134.
27白雪琴,周正华.疏肝健脾法治疗腹泻型肠易激综合征研究进展.江西中医药,2015,46(385):75-77.
28马冬颖,彭莉莉.四逆散合痛泻要方加味治疗腹泻型肠易激综合征疗效观察.山西中医,2016,32(1):16-17.
29杨梅,柳华,代二庆.乌梅丸治疗消化系统疾病应用概述.天津中医药大学学报,2015,34(2):125-128.
30陆为民,徐丹华,周晓波,等.徐景藩教授论治腹泻型肠易激综合征的经验.江苏中医药,2012,44(11):1-3.
31刘渡舟,傅士垣.伤寒论诠解.天津:科学技术出版社,1983:183.
32 Liu L,Yuan S F,Sun Y,et al.The possible mechanisms of Fructus Mume pill in the treatment of colitis induced by 2,4,6-trinitrobenzene sulfonic acid in rats.Journal of Ethnopharmcology,2009,126(3):557-564.
33王佳林.乌梅丸治疗溃疡性结肠炎的疗效观察及对血清IL-4和IL-8水平的影响.海南医学院学报,2014,20(1):80-82.
34杨宪章,刘广霞.穴位贴敷疗法与贴敷工具.上海针灸杂志,2011,30(5):350.