摘要
目的用循证医学的方法评价中西医结合治疗肝硬化腹水的临床疗效及安全性,为中西医结合治疗肝硬化腹水提供循证医学依据。方法按照国际Cochrane协作网的系统评价方法,检索2010年6月30日—2015年6月30日期间发表的关于中西医结合治疗肝硬化腹水的随机对照试验文献,并进行系统评价。根据改良Jadad质量评分评价文献研究的质量,采用Cochrane协作网提供的R evman5.0软件进行异质性检验、Meta分析和偏倚性分析。对于无法进行Meta分析的文献或数据给予定性描述。结果共纳入18篇文献。用改良Jadad文献评分量表评价,质量评分文献2分有4篇,1分有14篇。分析结果显示:中西结合治疗肝硬化腹水较单纯西医治疗可以显著提高总有效率;在改善ALT、AST、腹围、尿量、A/G上优于单纯西医组,但是对于白蛋白的影响与单纯西医组相似。由于几乎所有研究都没有报道失访及退出原因,且非多中心病例收集,随机及隐藏方法报道不详,不能确定是否存在选择性偏倚。漏斗图提示存在发表性偏倚。中西结合治疗措施安全性有待进一步考证。总结肝硬化腹水治疗方法驱邪以利水除湿为主,可活血化瘀,行气导滞;扶正以益气健脾为主,可滋阴养血、滋补肝肾。结论中西医结合治疗方案在治疗肝硬化腹水方面具有一定的优势,但高质量的研究文献较少,提示今后在研究的方法学上有待进一步完善。
Objective According to evidence-based medicine, to evaluate the effect of combined treatment of traditional Chinese and Western medicine in treating cirrhotic patients with ascites, to provide scientific basis for combining traditional Chinese and Western medicine in the treatment of cirrhosis ascites. Methods According to system evaluation method of the Cochrane collaboration, all the randomized controlled trails about combined treatment of traditional Chinese and Western medicine in the treatment of cirrhosis ascites were searched for systematic review. These researches published from June 30, 2010 to June 30, 2015. The Quality Improvement Jadad scores were used to evaluate the quality of literature research. In addition, the articles were analyzed with Revman5.0 software, including Meta analysis, heterogeneity analysis, sensitivity analysis and bias. If not for Meta analysis, these literature researches were described qualitatively. Resules 18 papers were included in the study. According to the quality Improvement Jadad scores, 4 articles for 2 points, and 14 articles for 1 points. The results showed that combination of Chinese and Western treatment of cirrhosis ascites has a better effect than Western medicine treatment. There is no literature reported lost to follow-up and exit, and it is the multicenter case collection, random method and random hidden method are not mentioned, selection bias cannot be determined at present. Funnel plots showed that there is publication bias. In the 18 researches, there are one research that is mentioned adverse reaction, and it is no mentioned in seventeen researches, so combination of traditional Chinese and Western medicine in the treatment of cirrhosis ascites security needs further research. In traditional Chinese medicine, main methods for the treatment of cirrhosis ascites include invigorating spleen to remove dampness, inducing diuresis for removing edema. Conclusion The reseach analysis showed the integrative treatment options have certain advantages in the treatment of ascites due to cirrhosis, but high quality research literature is less, so it is necessary to improve the research methods in the future.
出处
《中国中医药现代远程教育》
2017年第16期152-156,共5页
Chinese Medicine Modern Distance Education of China
关键词
肝硬化
腹水
中西医结合疗法
META分析
鼓胀
cirrhosis
ascites
therapy of integrated medicine
Meta-analysis
meteorism
