Xiao Jiao, Yang Yunfeng, Zhu Yuanrong, Qin Yan, Li Yifan, Fu Mengjie, Zhai Zhengdong, Zhu Lingyun
Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China.
Fenglin Community Health Service Center of Xuhui District, Shanghai 200030, China.
Evid Based Complement Alternat Med. 2018 May 24;2018:1505394. doi: 10.1155/2018/1505394. eCollection 2018.
Traditional Chinese medicine (TCM) therapy for nonerosive reflux disease (NERD) remains controversial. The aim of this study was to evaluate the efficacy and safety of TCM regimens in NERD treatment.
Randomized controlled trials (RCTs) of TCM treatment for NERD through September 31, 2017, were systematically identified in PubMed, Wanfang Data, CNKI, VIP, CBM, Ovid, Web of Science, and Cochrane Library databases. Quality assessment was performed by employing the Cochrane Risk of Bias assessment tool.
A total of 725 and 719 patients in 14 RCTs were randomly divided into TCM alone and conventional Western medicine groups, respectively. The clinical total effective rate of the TCM group was markedly higher than that of the single proton pump inhibitors (PPIs) or Prokinetics therapy group (RR = 1.19, 95% CI = 1.07-1.31, and = 0.0008), while it was comparable to that of the combination of PPIs and Prokinetics therapy group (RR = 1.14, 95% CI = 1.00-1.29, and = 0.05). Compared with Western medicine group, the TCM group showed improved symptom relief through a reduced RDQ score (SMD = -0.91; 95% CI = -1.68--0.15; and = 0.02). Additionally, TCM clearly decreased the recurrence rate (RR = 0.38, 95% CI = 0.28-0.52, and < 0.00001). Adverse events, such as constipation, sickness, fever, abdominal distension, and stomach noise, were slight for both the TCM and Western medicine groups and disappeared after the easement of pharmacological intervention; in particular, TCM possessed fewer side effects.
Compared with PPIs or Prokinetics therapy alone, TCM single therapy can better improve the clinical total effective rate and symptom relief and decrease the recurrence rate and adverse events in the treatment of NERD. Our results suggest that TCM will be a promising alternative therapy for NERD patients in the future.
中医治疗非糜烂性反流病（NERD）仍存在争议。本研究旨在评估中医方案治疗NERD的疗效和安全性。
通过在PubMed、万方数据、中国知网、维普资讯、中国生物医学文献数据库、Ovid、科学引文索引数据库和考克兰图书馆数据库中系统检索，找出截至2017年9月31日关于中医治疗NERD的随机对照试验（RCT）。采用考克兰偏倚风险评估工具进行质量评估。
14项RCT中的725例和719例患者分别被随机分为单纯中医组和传统西医组。中医组的临床总有效率显著高于单质子泵抑制剂（PPI）或促动力药治疗组（RR = 1.19，95%CI = 1.07 - 1.31，P = 0.0008），而与PPI和促动力药联合治疗组相当（RR = 1.14，95%CI = 1.00 - 1.29，P = 0.05）。与西医组相比，中医组通过降低反流疾病问卷（RDQ）评分改善了症状缓解情况（标准化均数差= -0.91；95%CI = -1.68 - -0.15；P = 0.02）。此外，中医明显降低了复发率（RR = 0.38，95%CI = 0.28 - 0.52，P < 0.00001）。便秘、恶心、发热、腹胀和胃鸣等不良事件在中医组和西医组中均较轻微，且在药物干预缓解后消失；特别是中医的副作用更少。
与单独使用PPI或促动力药治疗相比，中医单一疗法在治疗NERD时能更好地提高临床总有效率和症状缓解程度，并降低复发率和不良事件。我们的结果表明，中医在未来将成为NERD患者一种有前景的替代疗法。
