摘要
该文对中医药治疗溃疡性结肠炎(UC)的系统评价(Meta分析)再评价,为中医循证决策提供参考。遵照Overviews优先报告条目(preferred reporting items for overview of systematic reviews,PRIO-harms),计算机检索主要的中英文电子文献数据库(PubMed,Cochrane Library,EMbase,CNKI,CBM等),辅以手工检索,收集建库至2019年2月关于中医药治疗溃疡性结肠炎的系统评价。2名研究者独立进行文献筛选、资料提取,运用AMSTAR 2工具、PRISMA量表、GRADE系统分别评价文献的方法学质量、报告质量和证据质量,借助RevMan 5.3软件进行亚组分析。结果共纳入21篇系统评价,干预措施主要涉及中医内治法和外治法,有53个结局指标。AMSTAR 2评价结果显示,5篇为高质量,9篇为中等质量,4篇为低质量,3篇为极低质量。存在问题最多的条目分别为未提供排除文献清单、未报告各个研究的资助来源、实施前未确定研究方法。PRISMA量表平均分为(20.38±1.43)分,15篇得分小于22分,存在一定的报告缺陷。GRADE证据分级提示,30个结局指标的证据质量为低或极低,导致降级最主要因素为局限性,其次为发表偏倚、不一致性。结果表明:与常规西药相比,中药口服或灌肠治疗轻中度UC具有更好的临床疗效和安全性。考虑到目前SR方法学质量整体不高,需要进一步加强顶层设计,遵循科学研究范式,为中医临床循证决策提供更高级别证据。
This article is aimed to reevaluate the systematic reviews(Meta-analysis)of traditional Chinese medicine in the treatment of ulcerative colitis,and provide reference for evidence-based decision-making of traditional Chinese medicine(TCM).According to the preferred reporting items for overviews(preferred reporting items for overview of systematic reviews,PRIO-harms),the main Chinese and English electronic literature databases(PubMed,Cochrane Library,EMbase,CNKI,CBM,etc.)were retrieved,supplemented by manual retrieval.Systematic reviews for the treatment of ulcerative colitis with Chinese medicine up to February 2019 were included.Two researchers independently performed literature screening and data extraction.The methodology quality,reporting quality and evidence quality of the literature were evaluated by AMSTAR 2 tool,PRISMA scale and GRADE system respectively.Subgroup analysis was performed by using RevMan 5.3 software.A total of 21 systematic reviews were included,and the interventions mainly included TCM internal and external treatment,with 53 outcome indicators.The AMSTAR 2 results showed that 5 articles were of high quality,9 of medium quality,4 of low quality,and 3 of extremely low quality.The most problematic items were as follows:the list of excluded documents was not provided;the sources of funding for each study were not reported;and the research methods were not determined before implementation.PRISMA scale had an average score of(20.38±1.43)points,less than 22 points for 15 articles,with certain reporting defects.The GRADE system suggested that the quality of the evidence for the 30 outcome indicators was low or very low.The most important factors leading to degrading was the limitation,followed by publication bias and inconsistency.The results showed that as compared with conventional Western medicine,TCM oral or enema treatment for mild to moderate ulcerative colitis had better clinical efficacy and safety.Due to the quality limitations of the included studies,it is necessary to further strengthen the top-level design and follow the scientific research paradigm to provide a higher level of evidence for the clinical evidence-based decision-making of TCM.
作者
沈照峰
吴红辉
朱磊
周青
沈洪
SHEN Zhao-feng;WU Hong-hui;ZHU Lei;ZHOU Qing;SHEN Hong(School of Public Health,Nanjing Medical University,Nanjing 211166,China;Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)
出处
《中国中药杂志》
CAS
CSCD
北大核心
2020年第3期674-682,共9页
China Journal of Chinese Materia Medica
基金
国家自然科学基金面上项目(81873260)
国家中医药行业专项(201407001).
