辨证论治肝衰竭疗效的Meta分析
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摘要
目的
肝衰竭是多种因素引起的严重肝损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血机制障碍和黄疸、肝性脑病、腹水等为主要表现的一组临床症候群。在我国引起肝衰竭的主要病因是乙型肝炎病毒,其次是药物、乙醇或化学毒物所致的肝损害。Wilson病、自身免疫性肝炎、妊娠急性脂肪肝等也可导致肝衰竭,还有部分肝衰竭病因不明。酒精性肝损害常因肝硬化而导致慢性肝衰竭,但有些患者可因发生酒精性肝炎而出现急性或亚急性肝衰竭征象。在我国,真正的急性、亚急性肝衰竭比较少见,而在慢性HBV相关肝病基础上发生的慢加急性(或亚急性)肝衰竭最为常见。肝衰竭的病情复杂,预后凶险,死亡率高。中医理论中没有肝衰竭的专门论述。但与“黄疸”、“血证”、“臌胀”、“昏迷”等中医病症有关。究其病因主要是外感湿热疫毒之邪,内因与正气亏虚有关。湿热毒盛,弥漫三焦,侵犯脾胃,损伤肝胆.致胆汁排泄不循常道,浸渍于肌肤而发黄,属中医“急黄…瘟黄”范畴。并因其具有传染性而称之为“瘟黄”、“天行发黄”。合并出血、腹水、神昏谵语时,则与“血证”、“臌胀”、“昏迷”等病证有关。其主要病机为毒热炽盛.热毒内陷.湿浊蒙蔽,气滞血阻。文献表明,不同中医辨证施治用于肝衰竭的治疗取得较好疗效。如在活血化瘀的基础上重用赤芍、丹皮等凉血活血药治疗重度黄疸。应用大黄制剂通腑导浊、排毒、改变肠道pH以祛邪,同时应用血余炭等有吸附、燥湿、助运作用的中药恢复肠粘膜屏障作用以固本,经口服或灌肠治疗肠源性内毒素血症。提出辨证分型与分期治疗,多数学者认为重肝早期以毒热炽盛为主.邪在气分,治宜清热化湿、通腑泻浊;中期邪入营血,正邪交争,治宜扶正祛邪兼固。祛邪注意毒热、痰湿、瘀血的清除。扶正注意益气、养阴、温阳以“存津液、保胃气”;晚期邪陷正脱,治宜开闭、同脱、救逆等。本文的目的是系统评价辨证论治对肝衰竭的疗效。
方法
检索国内1997-2007年公开发表的中医辨证治疗肝衰竭的相关论文及会议论文,包括计算机检索、手工检索和从综述的参考文献中追踪查询的资料等。计算机检索的是生物医学文献光盘数据库(CBM)、中国期刊网、万方和维普全文文献数据库。人工检索在我院图书馆进行。提取其中的有效率和死亡率等资料,应用国际循证医学协作网提供的统计软件Revman4.2对所收集的数据进行统计,计算治疗结束后发生死亡结局的优势比(OR)、临床有效率的优势比(OR)、95%可信区间(C1),明确各研究效应量同质后,采用固定效应模型作合并效应量估计并进行异质性检验和敏感性分析。
结果
Meta分析结果提示①治疗组死亡优势比对照组要低,OR=0.39,95%可信区间0.27-0.57。②治疗组临床有效率优势比对照组要高,OR=3.44,95%可信区间2.40-4.92。敏感性分析未见结果逆转。
Objective liver failure is caused by many factors of severe liver damage,leading to its synthesis,detoxification,excretion and biotransformation functions of serious obstacles or decompensation appeared to clotting mechanism obstacles and jaundice,hepatic encephalopathy,ascites,such as major the performance of a group of clinical syndrome.In China caused a major cause of liver failure is the hepatitis B virus,followed by drugs,alcohol or chemical toxicant-induced liver damage.Wilson disease,autoimmune hepatitis,acute fatty liver of pregnancy,also can lead to liver failure,there are some liver failure of unknown etiology. Alcohol-induced liver damage due to cirrhosis caused by chronic liver failure,but some patients may be due to alcohol-induced hepatitis and acute or subacute signs of liver failure.In China, the true acute,sub-acute liver failure is relatively rare,and in HBV-related chronic liver disease based on the occurrence of acute (or subacute) the most common liver failure.Hepatic failure complicated illness,prognosis dangerous,high mortality.Chinese medicine theory is not devoted to liver failure.But with "jaundice", "Blood","dropsical bulging," "coma" and other diseases related to Chinese medicine.It is mainly the cause of evil exopathic humid, and the righteousness deficiency related to internal factors. Hygrothermal drug-sheng,diffuse Sanjiao,violations of the spleen and stomach,liver and gallbladder injury.Caused by biliary excretion not Road,impregnated in the skin and yellow,which is traditional Chinese medicine "radical Huang…Pyricularia yellow" areas.And because of its contagious and known as the "yellow plague","yellow-day trip." Hemorrhage,ascites,delirium,then with the "blood evidence","dropsical bulging," "coma" and other related diseases.The main pathogenesis for drug hot flourishing. Reduqing invagination.Wet muddy deceived,obstructing blood stagnation of qi.Documents show that TCM treatment for liver failure to obtain better treatment efficacy.If the basis of huoxuehuayu reuse Chishao,paeonol Liangxue Huoxue drugs,such as the treatment of severe jaundice.Rhubarb preparation guide Tongfu turbidimetry,detoxification,changes in intestinal pH to.At the same time,more than the application of blood,such as carbon adsorption,dampness,and assist the operation of traditional Chinese medicine used to restore the role of intestinal barrier in order to consolidate,by oral or enema treatment intestinal endotoxemia.Syndromes and proposed a phased treatment,the majority of scholars believe that heavy early liver toxicity mainly thermal flourishing.Evil in the air hours.Qingre Huashi,muddy torrents Tongfu;mid-evil into the business of blood,failed to pay disputeuphold and solid.Attention to drug heat,dampness,blood clearance.Fuzheng attention Yiqi,Yangyin,Onyang to "keep body fluid,Bao Wei Qi";late evil depression are offopening and closing, with off and so save the inverse.The purpose of this paper is the systematic evaluation of Treatment of liver failure patients.
Methods domestic 1997-2007 published in TCM treatment of liver failure related papers and conference papers,including computer searches,manual searches and references from the Summary of tracking query information.Computer Retrieval of biomedical literature is the CD-ROM Database(CBM),China Journal Net,VIP万方and the full text of the literature database.Manual search in our hospital library.Extraction of them efficient and mortality data,the application of the international collaborative network of evidence-based medicine provided by statistical software Revman4.2 of the data collected by statistical calculation of the treatment outcome after the death of the odds ratio(OR),the clinical efficiency The odds ratio(OR),95%confidence interval (C1),a clear effect of the study after the same amount of the use of fixed-effect model for combined effect of the volume and heterogeneity of the estimated testing and sensitivity analysis.
Results Meta analysis of the results suggest that the treatment group died①edge lower than the control group,OR = 0.39,95%CI 0.27 to 0.57.②efficient clinical treatment group edge higher than the control group,OR = 3.44,95%CI 2.40 4.92.No reversal of the results of sensitivity analysis.
肝衰竭是多种因素引起的严重肝损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血机制障碍和黄疸、肝性脑病、腹水等为主要表现的一组临床症候群。在我国引起肝衰竭的主要病因是乙型肝炎病毒,其次是药物、乙醇或化学毒物所致的肝损害。Wilson病、自身免疫性肝炎、妊娠急性脂肪肝等也可导致肝衰竭,还有部分肝衰竭病因不明。酒精性肝损害常因肝硬化而导致慢性肝衰竭,但有些患者可因发生酒精性肝炎而出现急性或亚急性肝衰竭征象。在我国,真正的急性、亚急性肝衰竭比较少见,而在慢性HBV相关肝病基础上发生的慢加急性(或亚急性)肝衰竭最为常见。肝衰竭的病情复杂,预后凶险,死亡率高。中医理论中没有肝衰竭的专门论述。但与“黄疸”、“血证”、“臌胀”、“昏迷”等中医病症有关。究其病因主要是外感湿热疫毒之邪,内因与正气亏虚有关。湿热毒盛,弥漫三焦,侵犯脾胃,损伤肝胆.致胆汁排泄不循常道,浸渍于肌肤而发黄,属中医“急黄…瘟黄”范畴。并因其具有传染性而称之为“瘟黄”、“天行发黄”。合并出血、腹水、神昏谵语时,则与“血证”、“臌胀”、“昏迷”等病证有关。其主要病机为毒热炽盛.热毒内陷.湿浊蒙蔽,气滞血阻。文献表明,不同中医辨证施治用于肝衰竭的治疗取得较好疗效。如在活血化瘀的基础上重用赤芍、丹皮等凉血活血药治疗重度黄疸。应用大黄制剂通腑导浊、排毒、改变肠道pH以祛邪,同时应用血余炭等有吸附、燥湿、助运作用的中药恢复肠粘膜屏障作用以固本,经口服或灌肠治疗肠源性内毒素血症。提出辨证分型与分期治疗,多数学者认为重肝早期以毒热炽盛为主.邪在气分,治宜清热化湿、通腑泻浊;中期邪入营血,正邪交争,治宜扶正祛邪兼固。祛邪注意毒热、痰湿、瘀血的清除。扶正注意益气、养阴、温阳以“存津液、保胃气”;晚期邪陷正脱,治宜开闭、同脱、救逆等。本文的目的是系统评价辨证论治对肝衰竭的疗效。
方法
检索国内1997-2007年公开发表的中医辨证治疗肝衰竭的相关论文及会议论文,包括计算机检索、手工检索和从综述的参考文献中追踪查询的资料等。计算机检索的是生物医学文献光盘数据库(CBM)、中国期刊网、万方和维普全文文献数据库。人工检索在我院图书馆进行。提取其中的有效率和死亡率等资料,应用国际循证医学协作网提供的统计软件Revman4.2对所收集的数据进行统计,计算治疗结束后发生死亡结局的优势比(OR)、临床有效率的优势比(OR)、95%可信区间(C1),明确各研究效应量同质后,采用固定效应模型作合并效应量估计并进行异质性检验和敏感性分析。
结果
Meta分析结果提示①治疗组死亡优势比对照组要低,OR=0.39,95%可信区间0.27-0.57。②治疗组临床有效率优势比对照组要高,OR=3.44,95%可信区间2.40-4.92。敏感性分析未见结果逆转。
Objective liver failure is caused by many factors of severe liver damage,leading to its synthesis,detoxification,excretion and biotransformation functions of serious obstacles or decompensation appeared to clotting mechanism obstacles and jaundice,hepatic encephalopathy,ascites,such as major the performance of a group of clinical syndrome.In China caused a major cause of liver failure is the hepatitis B virus,followed by drugs,alcohol or chemical toxicant-induced liver damage.Wilson disease,autoimmune hepatitis,acute fatty liver of pregnancy,also can lead to liver failure,there are some liver failure of unknown etiology. Alcohol-induced liver damage due to cirrhosis caused by chronic liver failure,but some patients may be due to alcohol-induced hepatitis and acute or subacute signs of liver failure.In China, the true acute,sub-acute liver failure is relatively rare,and in HBV-related chronic liver disease based on the occurrence of acute (or subacute) the most common liver failure.Hepatic failure complicated illness,prognosis dangerous,high mortality.Chinese medicine theory is not devoted to liver failure.But with "jaundice", "Blood","dropsical bulging," "coma" and other diseases related to Chinese medicine.It is mainly the cause of evil exopathic humid, and the righteousness deficiency related to internal factors. Hygrothermal drug-sheng,diffuse Sanjiao,violations of the spleen and stomach,liver and gallbladder injury.Caused by biliary excretion not Road,impregnated in the skin and yellow,which is traditional Chinese medicine "radical Huang…Pyricularia yellow" areas.And because of its contagious and known as the "yellow plague","yellow-day trip." Hemorrhage,ascites,delirium,then with the "blood evidence","dropsical bulging," "coma" and other related diseases.The main pathogenesis for drug hot flourishing. Reduqing invagination.Wet muddy deceived,obstructing blood stagnation of qi.Documents show that TCM treatment for liver failure to obtain better treatment efficacy.If the basis of huoxuehuayu reuse Chishao,paeonol Liangxue Huoxue drugs,such as the treatment of severe jaundice.Rhubarb preparation guide Tongfu turbidimetry,detoxification,changes in intestinal pH to.At the same time,more than the application of blood,such as carbon adsorption,dampness,and assist the operation of traditional Chinese medicine used to restore the role of intestinal barrier in order to consolidate,by oral or enema treatment intestinal endotoxemia.Syndromes and proposed a phased treatment,the majority of scholars believe that heavy early liver toxicity mainly thermal flourishing.Evil in the air hours.Qingre Huashi,muddy torrents Tongfu;mid-evil into the business of blood,failed to pay disputeuphold and solid.Attention to drug heat,dampness,blood clearance.Fuzheng attention Yiqi,Yangyin,Onyang to "keep body fluid,Bao Wei Qi";late evil depression are offopening and closing, with off and so save the inverse.The purpose of this paper is the systematic evaluation of Treatment of liver failure patients.
Methods domestic 1997-2007 published in TCM treatment of liver failure related papers and conference papers,including computer searches,manual searches and references from the Summary of tracking query information.Computer Retrieval of biomedical literature is the CD-ROM Database(CBM),China Journal Net,VIP万方and the full text of the literature database.Manual search in our hospital library.Extraction of them efficient and mortality data,the application of the international collaborative network of evidence-based medicine provided by statistical software Revman4.2 of the data collected by statistical calculation of the treatment outcome after the death of the odds ratio(OR),the clinical efficiency The odds ratio(OR),95%confidence interval (C1),a clear effect of the study after the same amount of the use of fixed-effect model for combined effect of the volume and heterogeneity of the estimated testing and sensitivity analysis.
Results Meta analysis of the results suggest that the treatment group died①edge lower than the control group,OR = 0.39,95%CI 0.27 to 0.57.②efficient clinical treatment group edge higher than the control group,OR = 3.44,95%CI 2.40 4.92.No reversal of the results of sensitivity analysis.
引文
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