Wang Tao, Jin Wei, Huang Qianqian, Li Haotian, Zhu Yun, Liu Honghong, Cai Huadan, Wang Jiabo, Wang Ruilin, Xiao Xiaohe, Zhao Yanling, Zou Wenjun
College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
Department of Pharmacy, 302 Military Hospital of China, Beijing 100039, China.
Evid Based Complement Alternat Med. 2020 Sep 30;2020:7603410. doi: 10.1155/2020/7603410. eCollection 2020.
Traditional Chinese medicine (TCM) is used as an adjuvant drug for the treatment of chronic hepatitis B liver fibrosis and is used frequently. We still do not know which TCM has the best curative effect as an adjuvant drug. Therefore, we decided to use network meta-analysis to solve this problem.
We used the RevMan software (5.3) and Stata software (13.0) to achieve this network meta-analysis (NMA). The primary outcomes of this study were HA, LN, PCIII, and IV-C; the secondary outcomes of this study were AST, ALT, and HBV-DNA negative conversion rate, and the Cochrane risk-of-bias tool was used to assess the quality of the included studies. For all outcomes, the scissors funnel plot, Egger test, and Begg test were used to detect publication bias, and sensitivity analysis was used to investigate the stability of the results. And the meta-regression was used to explore the source of heterogeneity.
A total of 34 articles were included in this study. The study involved a total of 3199 patients, of which 1578 were assigned to the control group and 1621 patients were assigned to the experimental group. The number of men and women is roughly equal, and the average age is about 43 years old. In addition, nine treatment strategies were involved in this study. The combination of TCM and entecavir can significantly improve the patients' HA, LN, PCIII, IV-C, AST, ALT, and HBV-DNA negative conversion rates. The comprehensive evaluation results showed that FHC combined with entecavir has more advantages than other treatment strategies.
For improving the HBV-DNA negative conversion rates, adding TCM to the therapeutic strategies does not seem to show absolute superiority. Finally, FHC combined with entecavir is the best therapeutic strategy.
中药被用作治疗慢性乙型肝炎肝纤维化的辅助药物且使用频繁。我们仍不清楚哪种中药作为辅助药物疗效最佳。因此，我们决定采用网状Meta分析来解决这一问题。
我们使用RevMan软件（5.3版）和Stata软件（13.0版）来进行这项网状Meta分析（NMA）。本研究的主要结局指标为透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PCIII）和Ⅳ型胶原（IV-C）；次要结局指标为谷草转氨酶（AST）、谷丙转氨酶（ALT）和乙肝病毒脱氧核糖核酸（HBV-DNA）阴转率，并且使用Cochrane偏倚风险工具来评估纳入研究的质量。对于所有结局指标，采用剪叉漏斗图、Egger检验和Begg检验来检测发表偏倚，并使用敏感性分析来研究结果的稳定性。同时采用Meta回归来探索异质性来源。
本研究共纳入34篇文章。研究共涉及3199例患者，其中1578例被分配至对照组，1621例患者被分配至试验组。男女数量大致相等，平均年龄约43岁。此外，本研究涉及9种治疗策略。中药与恩替卡韦联合使用可显著提高患者的HA、LN、PCIII、IV-C、AST、ALT水平以及HBV-DNA阴转率。综合评价结果显示，扶正化瘀胶囊（FHC）联合恩替卡韦比其他治疗策略更具优势。
对于提高HBV-DNA阴转率而言，在治疗策略中添加中药似乎并未显示出绝对优势。最后，FHC联合恩替卡韦是最佳治疗策略。
