疏肝健脾法治疗腹泻型肠易激综合征随机对照试验meta分析

发布时间：2019-04-19 21:39

【摘要】：目的:运用循证医学方法,对疏肝健脾中药治疗腹泻型肠易激综合征(IBS-D)进行系统评价和Meta分析,以图表和数据说明疏肝健脾法治疗腹泻型肠易激综合征的临床疗效,由此对疗效和安全性做出客观、可信的评价,为评价疏肝健脾法治疗IBS-D的临床疗效提供证据。方法:计算机检索中国生物医学文献数据库(China Biology Medicine disc,CBM)、相关期刊论文(China National Knowledge Infrastructure,CNKI)、维普中国科技期刊全文数据库(VIP Database)和万方医药期刊数据库(Wan-fang database),检索时间限定为建库至2015年12月。检索词包括:腹泻型肠易激综合征,疏肝健脾法,肝郁脾虚。检索式为:("腹泻型肠易激综合征")AND("疏肝健脾法")OR("肝郁脾虚")。结果:计算机共检索获得相关文献96篇,通过软件查重剔除文献34篇,阅读题目和摘要排除不符合纳入标准的39篇,后阅读全文复筛12篇,另外无法获得数据3篇,共纳入分析8篇。研究所纳入的8个RCT均报道了临床疗效,共669例患者,其中试验组362例,对照组307例。异质性检验分析显示8个研究间存在同质性(p=0.97,I2=0%),因此可采用固定效应模型合并分析。根据meta分析结果显示的森林图,合并试验组和对照组治疗腹泻型肠易激综合征的总有效率分别为333/362(91.99%)和224/307(72.96%)。meta分析结果显示,疏肝健脾法组与单纯西药治疗组差异具有统计学意义(P0.00001,临床疗效的合并效应量以及95%CI为[OR=4.27,95%CI(2.69,6.77)],漏斗图显示图形散点分布不呈现左右对称,考虑可能存在发表偏倚或试验方法学质量低下。结论:疏肝健脾法治疗腹泻型肠易激综合征临床疗效明显优于单纯西药治疗。结论的稳定性还需更多多中心、大样本、随机双盲的高质量临床试验支持,进一步提高分析结果的可靠性。
[Abstract]:Objective: to systematically evaluate and Meta the treatment of diarrhea-type irritable bowel syndrome (IBS-D) by using evidence-based medicine (EBM), and to illustrate the clinical efficacy of soothing liver and invigorating spleen in treating diarrhea-induced irritable bowel syndrome (IBS) with charts and data. Objective and credible evaluation of curative effect and safety was made to provide evidence for evaluating the clinical efficacy of soothing liver and invigorating spleen in the treatment of IBS-D. Methods: the Chinese Biomedical Literature Database (China Biology Medicine disc,CBM) and the Chinese Journal full-text Database (China National Knowledge Infrastructure,CNKI) were searched by computer. The full-text database of Chinese sci-tech journals (VIP Database) and Wanfang Medical Journal Database (Wan-fang database),) are limited to the establishment of the database until December 2015. The retrieval terms included diarrhea irritable bowel syndrome, soothing liver and invigorating spleen, liver depression and spleen deficiency. The key types were: ("diarrhea-type irritable bowel syndrome") AND ("soothing liver and invigorating spleen") OR ("liver stagnation and spleen deficiency"). Results: a total of 96 related literatures were retrieved by computer, 34 were excluded by software search, 39 were excluded from reading questions and abstracts, 12 were re-screened after reading, and 3 were unable to get data. A total of 8 articles were included in the analysis. A total of 669 patients, including 362 patients in the experimental group and 307 patients in the control group, were enrolled in the study. The clinical efficacy was reported in all of the 8 RCT patients included in the study. Heterogeneity test analysis showed that there were homogeneity among the eight studies (p = 0.97, I _ 2 ~ 0%), so fixed effect model could be used to combine analysis. According to the forest map showed by meta analysis, the total effective rates of the combined test group and the control group in treating diarrhea-type irritable bowel syndrome were 333, 362 (91.99%) and 224 ~ 307 (72.96%), respectively. The results of meta-analysis showed that the total effective rates for the treatment of diarrhea-type irritable bowel syndrome were 333. There was significant difference between the treatment group of soothing liver and invigorating spleen and the treatment group of western medicine alone (P0.00001, the combined effect of clinical efficacy and 95%CI was [OR=4.27,95%CI (2.69, 6.77)], The funnel diagram shows that the distribution of scatter points is not left-right symmetry, considering that there may be publication bias or poor quality of test methodology. Conclusion: the therapeutic effect of soothing liver and invigorating spleen on diarrhea irritable bowel syndrome is better than that of western medicine alone. Conclusion more central, large samples and randomized double blind high quality clinical trials are needed to further improve the reliability of the analysis results.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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