中西医结合治疗原发性胆汁性肝硬化（胆管炎）的Meta分析

发布时间：2018-05-19 02:11

本文选题：中医药 + 中西医结合　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:中医药治疗原发性胆汁性肝硬化(Primary biliary cirrhosis,PBC)虽然具有一定的成效,但是仍处于探索阶段,缺乏系统规律的标准和循证学依据。通过Meta分析整合小样本临床实验研究,扩大样本量,进而得出更加可靠的结论,为临床PBC的中医药治疗提供一定的参考。方法:检索Medline、Embase、Pubmed、Cochrane Library、维普、中国知网、万方、中医药在线等数据库中有关中医药或中西医结合治疗PBC的随机对照实验的文献及会议论文。两名研究员单独进行文献筛选、质量评估并提取信息资料,采用改良Jadad量表行文献质量评估。选取有效率、肝功能、肝纤维化指标以及免疫学指标为疗效指标。采用Rev Man5.3软件对数据进行处理,选用比值比(Odds ratio,OR)及95%可信区间(Confidence interval,CI)表示二分类计数资料,以加权均数差(Weighted mean difference,WMD)及其95%可信区间(Confidence interval,CI)表示连续计量资料。结果:最终纳入了39篇符合要求的文献,总样本量为2434,高质量文献4篇,低质量文献35篇;对照组均予以熊去氧胆酸(Ursodeoxycholic acid,UDCA)治疗作为条件对照,实验组在对照组的基础上加用中药汤剂或中成药治疗;Meta分析结果显示实验组与对照组在有效率、肝功能、肝纤维化指标以及免疫学指标Ig M、Ig G的比较中有显著性差异,在免疫学指标2型抗线粒体抗体(AMA-M2)比较中无显著性差异。结论:UDCA在PBC的治疗中仍然起着举足轻重的地位;中医药治疗PBC无外乎以扶正祛邪为根本治疗大法,扶正则以滋补肝肾、益气养血为主;祛邪则以清利湿热、活血化瘀、舒肝理气为主;中西医结合治疗PBC在提高有效率,改善肝功能、肝纤维化指标以及某些免疫学指标方面比单纯使用西药更有优势。
[Abstract]:Objective: traditional Chinese medicine (TCM) in the treatment of primary biliary cirrhosis is still in the stage of exploration, and lacks the standard of systematic law and the evidence based basis. Through Meta analysis and integration of small samples of clinical experimental research, expand sample size, and then draw a more reliable conclusion, for clinical PBC treatment of traditional Chinese medicine to provide a certain reference. Methods: the literatures and conference papers on randomized controlled trials of Chinese medicine or combination of traditional Chinese medicine and western medicine for PBC were searched in Medlinea Embase Pubmedmedmeda Cochrane Library, Weip, China Zhiwang, Wanfang, and Chinese Medicine online. The two researchers conducted literature screening, quality assessment and extraction of information data separately. The modified Jadad scale was used to evaluate the literature quality. The effective rate, liver function, liver fibrosis index and immunological index were selected as therapeutic indexes. The Rev Man5.3 software was used to process the data. The ratio of odds ratio (odds ratio) and 95% confidence interval (CI) were used to represent the two classified counting data, and the weighted mean difference (weighted mean difference) and 95% confidence interval (CI) were used to represent the continuous measurement data. Results: 39 articles were included, the total sample size was 2434, the high quality literature was 4, the low quality literature was 35, and the control group was treated with Ursodeoxycholic acid (UDCA) as a condition control, and the control group was treated with ursodeoxycholic acid (UDCA). The results of Meta-analysis showed that the effective rate, liver function, liver fibrosis index and immunological index Ig MMC Ig G were significantly different between the experimental group and the control group. There was no significant difference in immunological index type 2 anti mitochondrial antibody (AMA-M2). Conclusion: the treatment of PBC still plays an important role in the treatment of PBC. The traditional Chinese medicine treatment of PBC is nothing more than the treatment of nourishing the qi and kidney, nourishing the liver and kidney, nourishing qi and nourishing the blood, and dispelling evil by clearing away dampness and heat, activating blood circulation and removing blood stasis. The combination of traditional Chinese and western medicine has more advantages in improving the effective rate, improving liver function, liver fibrosis index and some immunological indexes than using western medicine alone.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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