利胆退黄法治疗急性胆源性胰腺炎临床疗效的Meta分析
|
摘要
目的对国内外已发表的有关利胆退黄法治疗胆源性胰腺炎临床疗效进行Meta分析。方法计算机检索Pubmed、Cochrane Library、CNKI、VIP、Wan Fang Data、CBM、PHM以及CSCI数据库,检索时限为建库至2018年6月,2名评价者独立筛选文献、提取资料和评价纳入研究偏倚后,采用Rev Man5. 3软件进行Meta分析。结果最终纳入11项随机对照试验(RCT),总病例数841例。分析结果显示,与对照组比较,利胆退黄法联合常规西药治疗急性胆源性胰腺炎(ABP)临床有效率更高[OR=3. 67,95%CI(1. 93,7. 01),P <0. 000 01],并能降低血淀粉酶[MD=-33. 35,95%CI(-42. 95,-23. 74),P <0. 000 01]、尿淀粉酶水平[MD=-133. 93,95%CI(-151. 60,-116. 26),P <0. 000 01];缩短血淀粉酶恢复时间[MD=-1. 67,95%CI(-2. 59,-0. 76),P <0. 000 01]、尿淀粉酶恢复时间[MD=-0. 95,95%CI(-1. 02,-0. 88),P <0. 000 01];降低CRP水平[MD=-7. 17,95%CI(-8. 06,-5. 74),P <0. 000 01];明显缩短住院时间[MD=-2. 31,95%CI(-2. 68,-1. 93),P <0. 000 01]。结论在常规治疗ABP的基础上联合利胆退黄法,可提高临床疗效,降低血、尿淀粉酶水平,减少炎症反应发生,缩短患者住院时间。但纳入文献质量偏低,需高质量RCT进一步验证。
Objective To conduct the meta-analysis on the clinical efficacy of lidan tuihuang method( the therapy for benefiting the gallbladder and reducing jaundice) on acute biliary pancreatitis. Methods The Pubmed,Cochrane Library,CNKI,VIP,Wanfang data,CBM,PHM and CSCI databases were retrieved from the time of database establishment to June 2018. 2 reviewers screened the literatures,extracted data and evaluated the bias of the included trials independently.Afterwards,using RevM an 5. 3 software,the meta-analysis was conducted. Results Finally,11 RCTs were included,with841 cases. The analysis results showed that compared with the control group,the clinical effective rate of the combined medication of lidan tuihuang method and the routine western medicine was much higher in the treatment of acute biliary pancreatitis[OR = 3. 67,95% CI( 1. 93,7. 01),P < 0. 000 01]. The treatment reduced amylase in blood[MD =-33. 35,95% CI(-42. 95,-23. 74),P < 0. 000 01]and in urine[MD =-133. 93,95% CI(-151. 60,-116. 26),P < 0. 000 01],shortened the recovery time of amylase in blood[MD =-1. 67,95% CI(-2. 59,-0. 76),P < 0. 000 01]and in urine[MD =-0. 95,95% CI(-1. 02,-0. 88),P < 0. 000 01],reduced CRP[MD =-7. 17,95% CI(-8. 06,-5. 74),P< 0. 000 01]and obviously shortened the length of stay[MD =-2. 31,95% CI(-2. 68,-1. 93),P < 0. 000 01]. Conclusion On the base of the routine treatment of acute biliary pancreatitis,lidan tuihuang method improves the clinical efficacy,reduced amylase in blood and urine and the inflammatory reaction,and shortens the length of stay. But,the quality of the included literatures is low. It needs the RCTs of the high quality to give a further verification.
Objective To conduct the meta-analysis on the clinical efficacy of lidan tuihuang method( the therapy for benefiting the gallbladder and reducing jaundice) on acute biliary pancreatitis. Methods The Pubmed,Cochrane Library,CNKI,VIP,Wanfang data,CBM,PHM and CSCI databases were retrieved from the time of database establishment to June 2018. 2 reviewers screened the literatures,extracted data and evaluated the bias of the included trials independently.Afterwards,using RevM an 5. 3 software,the meta-analysis was conducted. Results Finally,11 RCTs were included,with841 cases. The analysis results showed that compared with the control group,the clinical effective rate of the combined medication of lidan tuihuang method and the routine western medicine was much higher in the treatment of acute biliary pancreatitis[OR = 3. 67,95% CI( 1. 93,7. 01),P < 0. 000 01]. The treatment reduced amylase in blood[MD =-33. 35,95% CI(-42. 95,-23. 74),P < 0. 000 01]and in urine[MD =-133. 93,95% CI(-151. 60,-116. 26),P < 0. 000 01],shortened the recovery time of amylase in blood[MD =-1. 67,95% CI(-2. 59,-0. 76),P < 0. 000 01]and in urine[MD =-0. 95,95% CI(-1. 02,-0. 88),P < 0. 000 01],reduced CRP[MD =-7. 17,95% CI(-8. 06,-5. 74),P< 0. 000 01]and obviously shortened the length of stay[MD =-2. 31,95% CI(-2. 68,-1. 93),P < 0. 000 01]. Conclusion On the base of the routine treatment of acute biliary pancreatitis,lidan tuihuang method improves the clinical efficacy,reduced amylase in blood and urine and the inflammatory reaction,and shortens the length of stay. But,the quality of the included literatures is low. It needs the RCTs of the high quality to give a further verification.
引文
[1]杨尹默,陈依然.《日本急性胰腺炎治疗指南(2015)》评介[J].中国实用外科杂志,2016,36(1):75-78.
[2]急性胰腺炎协作组.中国6223例急性胰腺炎病因及病死率分析[J].胰腺病学,2006,6(6):321-325.
[3]Yokoe M,Takada T,Mayumi T,et al. Japanese guidelines for themanagement of acute panc-reatitis:Japanese Guidelines 2015[J]. JHepatobiliary Pancreat Sci,2015,22(6):405-432.
[4]张诚,杨玉龙,林美举,等.急性胆源性胰腺炎诊治的几点思考[J].肝胆胰外科杂志,2012,24(2):169-172.
[5]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013,上海)[J].胃肠病学,2013,18(7):428-433.
[6]张声生,李乾构,李慧臻,等.急性胰腺炎中医诊疗专家共识意见[J].中华中医药杂志,2013,28(6):1826-1831.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:36-39.
[8]林旭榕,徐丽娜.中西医结合治疗急性胆源性胰腺炎疗效观察[J].中国中医药信息杂志,2007,14(5):67-68.
[9]隋雪松,冷大跃,苏劲松,等.利胆清胰汤联合ERCP治疗胆源性胰腺炎临床观察[J].内蒙古中医药,2013,32(9):59-60.
[10]许卫华,王微,吕冉,等.大柴胡汤合茵陈蒿汤加减配合西药治疗急性胆源性胰腺炎的临床研究[J].环球中医药,2013,6(4):249-252.
[11]张书剑,王林青.中西医结合治疗急性胆源性胰腺炎36例临床观察[J].四川中医,2014,32(10):85-86.
[12]巩阳,朱红,陆宇平,等.中药联合内镜介入治疗急性胆源性胰腺炎的临床观察[J].世界中西医结合杂志,2014,9(6):611-613.
[13]张慧波.清胰利胆汤治疗急性胆源性胰腺炎的效果分析[J].中国卫生标准管理,2015,6(15):157-158.
[14]郭勇,蒲邦明.中西医结合治疗急性胆源性胰腺炎36例临床观察[J].内蒙古中医药,2015,34(5):68-69.
[15]姜燕,张弘英,罗文,等.利胆清胰汤联合ERCP治疗肝胆湿热证胆源性胰腺炎的临床疗效研究[J].中药药理与临床,2015,31(2):115-116.
[16]梁勋利,汪栋宇,莫伟明.清胰利胆汤联合善宁治疗急性胆源性胰腺炎疗效观察[J].医学理论与实践,2016,29(1):56-57.
[17]郑红珍.清热利胆通腑汤在急性胆源性胰腺炎胆囊切除术后的应用[J].中国中医药科技,2017,24(6):748-749.
[18]许强.中药利胆清胰汤辅助西医治疗急性胆源性胰腺炎的效果[J].甘肃科技,2017,33(17):131-132.
[19]许守平,孙备,姜洪池.急性胰腺炎若干研究进展[J].中国实用外科杂志,2009,29(7):604-606.
[20]王春友,李非,赵玉沛,等.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(1):4-7.
[21]Houssin D,Castaing D,Lemoine J,et al. Microlithiasis of the gall-bladder[J]. Surg Gynecol Obstet,1983,157(1):20-24.
[22]邱全兴,沈云志,张丽霞.胆道微结石在急性胆管炎中的临床意义[J].实用医学杂志,2008(12):2087-2089.
[23]蒯仂,施雪斐,吴人杰,等.中医理论创新之我见———以“利湿退黄”“利胆退黄”为例[J].上海中医药杂志,2017,51(6):13-15.
[24]林志智.中医利胆法及其临床运用浅谈[J].新中医,1986(1):1-3.
[25]吴海滨,佘世锋,兰绍阳.基于FXR探讨茵栀黄注射液利胆退黄的机制研究[J].辽宁中医杂志,2016,43(4):845-848.
[26]张达坤,杨永和,蔡敏,等.利胆退黄方治疗病毒性瘀胆型肝炎的临床研究[J].海南医学,2014,25(19):2830-2833.
[2]急性胰腺炎协作组.中国6223例急性胰腺炎病因及病死率分析[J].胰腺病学,2006,6(6):321-325.
[3]Yokoe M,Takada T,Mayumi T,et al. Japanese guidelines for themanagement of acute panc-reatitis:Japanese Guidelines 2015[J]. JHepatobiliary Pancreat Sci,2015,22(6):405-432.
[4]张诚,杨玉龙,林美举,等.急性胆源性胰腺炎诊治的几点思考[J].肝胆胰外科杂志,2012,24(2):169-172.
[5]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013,上海)[J].胃肠病学,2013,18(7):428-433.
[6]张声生,李乾构,李慧臻,等.急性胰腺炎中医诊疗专家共识意见[J].中华中医药杂志,2013,28(6):1826-1831.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:36-39.
[8]林旭榕,徐丽娜.中西医结合治疗急性胆源性胰腺炎疗效观察[J].中国中医药信息杂志,2007,14(5):67-68.
[9]隋雪松,冷大跃,苏劲松,等.利胆清胰汤联合ERCP治疗胆源性胰腺炎临床观察[J].内蒙古中医药,2013,32(9):59-60.
[10]许卫华,王微,吕冉,等.大柴胡汤合茵陈蒿汤加减配合西药治疗急性胆源性胰腺炎的临床研究[J].环球中医药,2013,6(4):249-252.
[11]张书剑,王林青.中西医结合治疗急性胆源性胰腺炎36例临床观察[J].四川中医,2014,32(10):85-86.
[12]巩阳,朱红,陆宇平,等.中药联合内镜介入治疗急性胆源性胰腺炎的临床观察[J].世界中西医结合杂志,2014,9(6):611-613.
[13]张慧波.清胰利胆汤治疗急性胆源性胰腺炎的效果分析[J].中国卫生标准管理,2015,6(15):157-158.
[14]郭勇,蒲邦明.中西医结合治疗急性胆源性胰腺炎36例临床观察[J].内蒙古中医药,2015,34(5):68-69.
[15]姜燕,张弘英,罗文,等.利胆清胰汤联合ERCP治疗肝胆湿热证胆源性胰腺炎的临床疗效研究[J].中药药理与临床,2015,31(2):115-116.
[16]梁勋利,汪栋宇,莫伟明.清胰利胆汤联合善宁治疗急性胆源性胰腺炎疗效观察[J].医学理论与实践,2016,29(1):56-57.
[17]郑红珍.清热利胆通腑汤在急性胆源性胰腺炎胆囊切除术后的应用[J].中国中医药科技,2017,24(6):748-749.
[18]许强.中药利胆清胰汤辅助西医治疗急性胆源性胰腺炎的效果[J].甘肃科技,2017,33(17):131-132.
[19]许守平,孙备,姜洪池.急性胰腺炎若干研究进展[J].中国实用外科杂志,2009,29(7):604-606.
[20]王春友,李非,赵玉沛,等.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(1):4-7.
[21]Houssin D,Castaing D,Lemoine J,et al. Microlithiasis of the gall-bladder[J]. Surg Gynecol Obstet,1983,157(1):20-24.
[22]邱全兴,沈云志,张丽霞.胆道微结石在急性胆管炎中的临床意义[J].实用医学杂志,2008(12):2087-2089.
[23]蒯仂,施雪斐,吴人杰,等.中医理论创新之我见———以“利湿退黄”“利胆退黄”为例[J].上海中医药杂志,2017,51(6):13-15.
[24]林志智.中医利胆法及其临床运用浅谈[J].新中医,1986(1):1-3.
[25]吴海滨,佘世锋,兰绍阳.基于FXR探讨茵栀黄注射液利胆退黄的机制研究[J].辽宁中医杂志,2016,43(4):845-848.
[26]张达坤,杨永和,蔡敏,等.利胆退黄方治疗病毒性瘀胆型肝炎的临床研究[J].海南医学,2014,25(19):2830-2833.