益气养阴法治疗老年性便秘的系统评价与Meta分析
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摘要
目的系统地评价益气养阴法治疗老年性便秘的临床疗效及其安全性。方法计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方医学数据库、维普数据库、Pub Med、Cochrane Library、EMbase等数据库,检索时间均从建库至2018年3月1日。并且手工检索《世界华人消化杂志》《中国中西医结合消化杂志》《中华中医药杂志》《中医杂志》《中国中西医结合杂志》等近两年的相关文献,对有关采用益气养阴法治疗老年性便秘的临床随机对照试验(RCT)进行筛选,按照Cochrane Handbook 5. 1标准进行资料提取,文献质量的评价,运用Rev Man 5. 3软件对提取的数据进行Meta分析。结果共纳入44项研究,合计4173例老年便秘患者。纳入的研究质量普遍偏低。Meta分析结果显示:与导泻剂相比,益气养阴方能够降低老年便秘的复发率(RR=0. 35; 95%CI=[0. 17,0. 72]),提高临床愈显率(RR=1. 89; 95%CI=[1. 60,2. 23]);与促胃肠动力药相比,益气养阴方能够明显提高临床愈显率(RR=1. 48; 95%CI=[1. 23,1. 79]);与综合西药相比,益气养阴方能够降低老年便秘的复发率(RR=0. 16; 95%CI=[0. 09,0. 30]),但在临床愈显率方面二者疗效相当(RR=1. 35; 95%CI=[0. 99,1. 85]);与中成药相比,在复发率(RR=0. 42; 95%CI=[0. 07,2. 37])方面二者无明显差异,然而益气养阴方能够提高临床愈显率(RR=1. 39; 95%CI=[1. 23,1. 57])。不良反应发生率方面,益气养阴方较其他药物发生率低。结论益气养阴方能够提高老年便秘患者的临床愈显率,降低复发率,具有良好的临床安全性,但是鉴于纳入研究的质量普遍较低,尚需更多多中心、高质量的临床研究予以验证。
Objective To review systematically the clinical effects and safety of yiqi yangyin formula in treatment of elderly constipation. Methods From CBM,CNKI,Wanfang,VIP,Pub Med,Cochrane Library and EMbase databases,the relevant articles were retrieved through to March 1,2018 since the database establishment. Additionally,the relevant articles in recent two years were retrieved manually from World Chinese Journal of Digestology,Chinese Journal of Integrated Traditional and Western Medicine on Digestion,Chinese Journal of Traditional Chinese Medicine and Pharmacy,Journal of Traditional Chinese Medicine,Chinese Journal of Integrated Traditional and Western Medicine. The randomized controlled trials(RCTs) of elderly constipation treated with yiqi yangyin formula were screened. According to the criteria of Cochrane Handbook 5. 1,the data were extracted and literature quality was evaluated. Using Rev Man 5. 3 software,meta-analysis was performed on the extracted data. Results A total of 44 eligible RCTs were included,with 4173 cases of elderly constipation. The quality of RCTs was generally low. Meta-analysis results showed that compared with purgative prescription,yiqi yangyin formula reduced the recurrence rate(RR = 0. 35; 95% CI =[0. 17,0. 72]) and improved clinical curative rate(RR = 1. 89; 95% CI = [1. 60,2. 23]). Compared with gastrointestinal excitomotor,yiqi yangyin formula obviously improved the clinical curative rate(RR = 1. 48; 95% CI =[1. 23,1. 79]). Compared with comprehensive western medicine,yiqi yangyin formula reduced the recurrence rate(RR = 0. 16; 95% CI =[0. 09,0. 30]),but the clinical curative rate was similar(RR = 1. 35; 95% CI =[0. 99,1. 85]). Compared with Chinese patent medicine,the difference was not significant in the recurrence rate(RR = 0. 42; 95% CI =[0. 07,2. 37]),but yiqi yangyin formula improves the clinical curative rate(RR = 1. 39; 95% CI =[1. 23,1. 57]). Regarding the incidence. Conclusion Yiqi yangyin formula improves clinical curative rate on elderly constipation and reduces the recurrence rate in the patients. It is safe in clinical application. But,because of the low quality of the enrolled RCTs,more multi-central and high-quality RCTs are required for further verification.
Objective To review systematically the clinical effects and safety of yiqi yangyin formula in treatment of elderly constipation. Methods From CBM,CNKI,Wanfang,VIP,Pub Med,Cochrane Library and EMbase databases,the relevant articles were retrieved through to March 1,2018 since the database establishment. Additionally,the relevant articles in recent two years were retrieved manually from World Chinese Journal of Digestology,Chinese Journal of Integrated Traditional and Western Medicine on Digestion,Chinese Journal of Traditional Chinese Medicine and Pharmacy,Journal of Traditional Chinese Medicine,Chinese Journal of Integrated Traditional and Western Medicine. The randomized controlled trials(RCTs) of elderly constipation treated with yiqi yangyin formula were screened. According to the criteria of Cochrane Handbook 5. 1,the data were extracted and literature quality was evaluated. Using Rev Man 5. 3 software,meta-analysis was performed on the extracted data. Results A total of 44 eligible RCTs were included,with 4173 cases of elderly constipation. The quality of RCTs was generally low. Meta-analysis results showed that compared with purgative prescription,yiqi yangyin formula reduced the recurrence rate(RR = 0. 35; 95% CI =[0. 17,0. 72]) and improved clinical curative rate(RR = 1. 89; 95% CI = [1. 60,2. 23]). Compared with gastrointestinal excitomotor,yiqi yangyin formula obviously improved the clinical curative rate(RR = 1. 48; 95% CI =[1. 23,1. 79]). Compared with comprehensive western medicine,yiqi yangyin formula reduced the recurrence rate(RR = 0. 16; 95% CI =[0. 09,0. 30]),but the clinical curative rate was similar(RR = 1. 35; 95% CI =[0. 99,1. 85]). Compared with Chinese patent medicine,the difference was not significant in the recurrence rate(RR = 0. 42; 95% CI =[0. 07,2. 37]),but yiqi yangyin formula improves the clinical curative rate(RR = 1. 39; 95% CI =[1. 23,1. 57]). Regarding the incidence. Conclusion Yiqi yangyin formula improves clinical curative rate on elderly constipation and reduces the recurrence rate in the patients. It is safe in clinical application. But,because of the low quality of the enrolled RCTs,more multi-central and high-quality RCTs are required for further verification.
引文
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[2]Drossman DA.The functional gastrointestinal disorders and the RomeⅢprocess[J].Gastroenterology,2006,130(5):1377-1390.
[3]熊理守,陈旻湖,陈惠新,等.广东省社区人群慢性便秘的流行病学研究[J].中华消化杂志,2004(8):43-46.
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[5]郭晓峰,柯美云,潘国宗,等.北京地区成人慢性便秘整群、分层、随机流行病学调查及其相关因素分析[J].中华消化杂志,2002(10):57-58.
[6]中国慢性便秘诊治指南(2013,武汉)[J].胃肠病学,2013,18(10):605-612.
[7]张萌,谢欣颖,袁媛,等.益气养阴法论治糖尿病便秘的Meta分析[J].辽宁中医杂志,2015,42(8):1380-1383,1599.
[8]彭兆龙.基于Meta分析的益气养阴法治疗功能性便秘的系统评价[D].济南:山东中医药大学,2016.
[9]刘利华,彭澎.益气养阴法合西药治疗慢传输型便秘临床研究[J].辽宁中医药大学学报,2008(1):86-87.
[10]陈玉昌.苁蓉更衣汤治疗老年性便秘76例[J].陕西中医,2008(1):56-57.
[11]林丽,陆军,吴国芳,等.便通胶囊治疗老年性便秘45例临床观察[J].湖南中医杂志,2015,31(1):47-48.
[12]雷晓梅.益气养阴法治疗功能性便秘(气阴两虚兼毒邪内蕴证)的临床研究[D].成都:成都中医药大学,2010.
[13]杨博文.益气养阴润肠汤治疗老年慢性功能性便秘(气虚肠燥型)的临床观察[D].昆明:云南中医学院,2017.
[14]陆景峰.芪术二仁汤治疗老年便秘临床观察[J].实用中医药杂志,2009,25(5):290-291.
[15]魏丽萍.益气养阴润肠汤治疗气阴两虚型老年功能性便秘的临床研究[D].郑州:河南中医药大学,2016.
[16]刘世举,刘佃温,张慧俭,等.通秘合剂治疗老年性便秘临床研究[J].中医学报,2015,30(9):1351-1353.
[17]杨会举,刘佃温.通秘合剂治疗便秘气阴两虚证临床研究[J].中医学报,2016,31(1):125-128.
[18]孟昭湖.自拟益气滋阴润肠通便汤加减治疗习惯性便秘临床研究[J].河北医学,2014,20(6):1021-1023.
[19]时玉昌.益气养阴治疗老年功能性便秘的临床和实验研究[D].南京:南京中医药大学,2007.
[20]魏妮,梁靖华,孙林梅,等.益气养阴汤与莫沙比利治疗老年气阴两虚型慢性便秘患者疗效对比[J].环球中医药,2017,10(1):94-96.
[21]何德才.益气养阴法治疗老年慢传输型便秘临床观察[J].四川中医,2010,28(12):78-79.
[22]曹成基.益气润肠汤治疗老年性便秘的临床观察[J].四川中医,2008(1):77-78.
[23]吴步炳.中药益气养血滋阴润肠法治疗老年慢性功能性便秘临床观察[J].现代中西医结合杂志,2009,18(17):2015-2016.
[24]布明亮.中药治疗老年慢性功能性便秘36例观察[J].实用中医药杂志,2010,26(9):614-615.
[25]赵鹤新.自拟益气润肠汤治疗老年性便秘42例疗效观察[J].中国社区医师(医学专业),2011,13(16):177-178.
[26]郭素芬.观察补元润通汤治疗老年性便秘的临床效果[J].北方药学,2017,14(5):183.
[27]叶萍,魏明.益气养阴润肠汤治疗气阴两亏型老年性便秘46例临床观察[J].四川中医,2015,33(11):107-108.
[28]杜义斌,杨柏风,王华宁,等.健脾润肠法治疗老年功能性便秘35例临床观察[J].云南中医中药杂志,2015,36(6):52-53.
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