中药治疗肝纤维化临床研究的系统评价
发布时间：2018-10-05 18:04
【摘要】：背景:肝纤维化是各种慢性肝病的重要病理特征,也是发展至肝硬化的必经阶段,因此,寻找有效药物,阻断、延缓及逆转肝纤维化已成为治疗慢性肝病中的一个关键性问题。正如国际现代肝病学的奠基人Hans Popper教授所说“谁能预防和治疗肝纤维化,谁就能治愈大多数慢性肝病”[1]。目前对肝纤维化的治疗尚无理想药物,而中药抗纤维化治疗的有效的报道日渐增多[2]。但是中药疗效并没有得到国际的广泛认同,中药抗纤维化的疗效也存在争议和质疑,为此本研究拟通过询证医学方法,分析当前中药抗纤维化疗效的客观现状,对中药抗纤维化的临床应用提供依据。目的:通过文献综合分析,判断中药治疗肝纤维化疗效的确切性。方法:计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普资讯网(VIP)、万方数据资源系统、百链数据库(Medalink)、Pub Med及Google学术搜索引擎中系统全面地进行文献搜索,检索的具体日期为从建库至2016年1月。纳入所有有关中药或中成药治疗肝纤维化的研究试验,同时查阅所有检出文献的参考文献作为补充,必要时与文献作者联系,进一步取得全文或相关试验数据。通过阅读文献题名、摘要或全文,排除不符合纳入标准的研究试验。选择肝纤维化评价的“金标准”肝组织病理学作为主要指标,辅以血清肝纤维化指标、肝生化及不良反应等指标,对纳入研究的文献进行质量评价和数据提取后,应用Rev Man5.3统计软件进行统计学分析。结果:最终有26篇符合纳入标准的文献,共2913例患者纳入临床评价,其中中药组2424例,对照组489例。所有研究对象均为肝纤维化病理分级S1-S4的患者,中药组以“中药或中成药或联合一般护肝药物”为主要治疗;对照组使用“一般护肝药物或安慰剂”为主要治疗。统计分析结果显示:治疗疗程为6个月时,与对照组相比,中药组在改善肝组织纤维化程度{WMD=1.97,95%CI[-3.60,-0.33],P=0.02}、肝组织炎症活动度{WMD=1.62,95%CI[-3.19,-0.05],P=0.04}、透明质酸(HA){SMD=1.48,95%CI[-2.26,-0.70],P=0.0002}、层粘连蛋白(LN){SMD=0.94,95%CI[-1.52,-0.35],P=0.002}、Ⅲ型前胶原(PC-Ⅲ){SMD=1.44,95%CI[-2.45,-0.42],P=0.005}、Ⅳ型胶原(Ⅳ-C){SMD=0.62,95%CI[-1.11,-0.12],P=0.01}、谷丙转氨酶(ALT){WMD=13.90,95%CI[-25.55,-2.25],P=0.02}、白蛋白(ALB){WMD=3.06,95%CI[0.65,5.47],P=0.01}方面均具有统计学意义。而中药组在降低总胆红素(TB){WMD=3.13,95%CI[-7.17,0.91],P=0.13}方面较对照组无统计学意义。结论:目前研究提示:1.中药可以改善肝组织学纤维化程度及炎症活动度;2.中药可以显著降低血清肝纤维化指标;3.中药对胆汁代谢影响不大。综上所述,中药对肝纤维化治疗是确切有效的。
[Abstract]:Background: hepatic fibrosis is an important pathological feature of various chronic liver diseases, and it is also a necessary stage for the development of liver cirrhosis. Therefore, finding effective drugs, blocking, delaying and reversing liver fibrosis has become a key problem in the treatment of chronic liver diseases. As Professor Hans Popper, founder of International Modern Hepatology, said, "whoever can prevent and treat liver fibrosis can cure most chronic liver diseases." [1] At present, there are no ideal drugs for the treatment of liver fibrosis, and the effective reports of antifibrosis therapy of traditional Chinese medicine are increasing day by day [2]. However, the curative effect of traditional Chinese medicine has not been widely accepted by the world, and the effect of anti-fibrosis of traditional Chinese medicine has also been disputed and questioned. Therefore, this study intends to analyze the current objective status of anti-fibrosis effect of traditional Chinese medicine by means of inquiry and evidence medicine. To provide the basis for the clinical application of traditional Chinese medicine in anti-fibrosis. Objective: to evaluate the efficacy of traditional Chinese medicine in the treatment of hepatic fibrosis by comprehensive literature analysis. Methods: the Chinese Biomedical Literature Database (CBM),) was searched by computer, and the (VIP), Wanfang data Resource system (VIP),) was used in the (CNKI), WIP Web of China knowledge Network (CNKI),). The literature search was carried out systematically and comprehensively in the 100-chain database (Medalink) / Pub Med and Google academic search engine. The specific date of retrieval is from the construction of the database to January 2016. To include all relevant Chinese medicine or traditional Chinese medicine in the treatment of liver fibrosis research trials, at the same time consult all the reference literature as a supplement, if necessary contact the author of the literature, further obtain the full text or related experimental data. Exclude research experiments that do not meet the inclusion criteria by reading the title, abstract, or full text of the literature. The "golden standard" liver histopathology of liver fibrosis evaluation was selected as the main index, supplemented by serum hepatic fibrosis index, liver biochemistry and adverse reactions, and the quality evaluation and data extraction of the literature involved in the study were carried out. Rev Man5.3 statistical software was used for statistical analysis. Results: there were 26 articles in accordance with the inclusion criteria. A total of 2913 patients were included in the clinical evaluation. There were 2424 cases in the traditional Chinese medicine group and 489 cases in the control group. All the subjects were patients with pathological grade S1-S4 of hepatic fibrosis. The traditional Chinese medicine group was treated mainly with "Chinese medicine or traditional Chinese medicine or combined general liver protection drug", while the control group with "general liver protection drug or placebo" as the main treatment. The results of statistical analysis showed that when the course of treatment was 6 months, compared with the control group, 涓嵂缁勫湪鏀瑰杽鑲濈粍缁囩氦缁村寲绋嬪害{WMD=1.97,95%CI[-3.60,-0.33],P=0.02},鑲濈粍缁囩値鐥囨椿鍔ㄥ害{WMD=1.62,95%CI[-3.19,-0.05],P=0.04},閫忔槑璐ㄩ吀(HA){SMD=1.48,95%CI[-2.26,-0.70],P=0.0002},灞傜矘杩炶泲鐧，
本文编号：2254343
[Abstract]:Background: hepatic fibrosis is an important pathological feature of various chronic liver diseases, and it is also a necessary stage for the development of liver cirrhosis. Therefore, finding effective drugs, blocking, delaying and reversing liver fibrosis has become a key problem in the treatment of chronic liver diseases. As Professor Hans Popper, founder of International Modern Hepatology, said, "whoever can prevent and treat liver fibrosis can cure most chronic liver diseases." [1] At present, there are no ideal drugs for the treatment of liver fibrosis, and the effective reports of antifibrosis therapy of traditional Chinese medicine are increasing day by day [2]. However, the curative effect of traditional Chinese medicine has not been widely accepted by the world, and the effect of anti-fibrosis of traditional Chinese medicine has also been disputed and questioned. Therefore, this study intends to analyze the current objective status of anti-fibrosis effect of traditional Chinese medicine by means of inquiry and evidence medicine. To provide the basis for the clinical application of traditional Chinese medicine in anti-fibrosis. Objective: to evaluate the efficacy of traditional Chinese medicine in the treatment of hepatic fibrosis by comprehensive literature analysis. Methods: the Chinese Biomedical Literature Database (CBM),) was searched by computer, and the (VIP), Wanfang data Resource system (VIP),) was used in the (CNKI), WIP Web of China knowledge Network (CNKI),). The literature search was carried out systematically and comprehensively in the 100-chain database (Medalink) / Pub Med and Google academic search engine. The specific date of retrieval is from the construction of the database to January 2016. To include all relevant Chinese medicine or traditional Chinese medicine in the treatment of liver fibrosis research trials, at the same time consult all the reference literature as a supplement, if necessary contact the author of the literature, further obtain the full text or related experimental data. Exclude research experiments that do not meet the inclusion criteria by reading the title, abstract, or full text of the literature. The "golden standard" liver histopathology of liver fibrosis evaluation was selected as the main index, supplemented by serum hepatic fibrosis index, liver biochemistry and adverse reactions, and the quality evaluation and data extraction of the literature involved in the study were carried out. Rev Man5.3 statistical software was used for statistical analysis. Results: there were 26 articles in accordance with the inclusion criteria. A total of 2913 patients were included in the clinical evaluation. There were 2424 cases in the traditional Chinese medicine group and 489 cases in the control group. All the subjects were patients with pathological grade S1-S4 of hepatic fibrosis. The traditional Chinese medicine group was treated mainly with "Chinese medicine or traditional Chinese medicine or combined general liver protection drug", while the control group with "general liver protection drug or placebo" as the main treatment. The results of statistical analysis showed that when the course of treatment was 6 months, compared with the control group, 涓嵂缁勫湪鏀瑰杽鑲濈粍缁囩氦缁村寲绋嬪害{WMD=1.97,95%CI[-3.60,-0.33],P=0.02},鑲濈粍缁囩値鐥囨椿鍔ㄥ害{WMD=1.62,95%CI[-3.19,-0.05],P=0.04},閫忔槑璐ㄩ吀(HA){SMD=1.48,95%CI[-2.26,-0.70],P=0.0002},灞傜矘杩炶泲鐧，
本文编号：2254343
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