Li Bo, Lin Yiyi, Nie Bo, Zhao Guozhen, Zhang Xiatian, Zhu Mengting, Hu Jing, Huang Po, Feng Shuo, Qiu Ruijin, Tian Guihua, Zhang Shengsheng, Shang Hongcai
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, China.
Beijing Evidence-based Chinese Medicine Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Ann Palliat Med. 2021 Dec;10(12):12985-13001. doi: 10.21037/apm-20-1135. Epub 2021 Aug 30.
Traditional Chinese medicine (TCM) may improve the prognosis management of cholelithiasis patients after gallbladder-preserving lithotripsy. To explore the evidence for this view, we systematically reviewed the efficacy and safety of TCM for improving the prognosis of cholelithiasis after gallbladder-preserving lithotripsy and performed functional pathway enrichment analysis of TCM target genes.
In this systematic review (SRs), we searched six Chinese or international databases to collect randomized controlled clinical trials (RCTs) of TCM in preventing the recurrence of cholelithiasis after gallbladder-preserving lithotripsy. The literature was independently screened by 2 reviewers, who then extracted the data. The Cochrane risk-of-bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tools were used to assess the included studies' risk of bias and quality of evidence, respectively. And, the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses would be conducted on the TCM prescriptions in the included literature to find the effective component and mechanism of TCM in the prognosis management of gallbladder-preserving lithotripsy. Analysis in this research would be conducted by R 3.5.2 software.
A total of 1,024 articles were retrieved, and 9 RCTs involving 926 participants were included after the step-by-step screening. The risk of bias for each important outcome in all the studies was "uncertain". The meta-analysis showed that compared with blank control, TCM prevented cholelithiasis by decreasing the recurrence rate, complications incidence, gallbladder wall thickness, and gallbladder contraction degree. But, there were no significant differences in the rate of the adverse reaction. The result of the GO and KEGG analysis revealed that the mechanism of prevention of TCM in gallstone recurrence may be related to the cholesterol metabolic pathway and that naringin from Glycyrrhiza may be the effective component in the prevention of recurrence.
Existing evidence suggests that the use of TCM may reduce the recurrence rate after gallbladder-preserving lithotripsy and this effect may be related to the flavonoid glycoside naringin from Glycyrrhiza uralensis, but more RCTs with high quality in this area may be needed to have a robust conclusion.
中医可能会改善保胆取石术后胆石症患者的预后管理。为探究这一观点的证据，我们系统评价了中医改善保胆取石术后胆石症预后的疗效和安全性，并对中医靶点基因进行了功能通路富集分析。
在本系统评价中，我们检索了6个中国或国际数据库，以收集中医预防保胆取石术后胆石症复发的随机对照临床试验（RCT）。文献由2名研究者独立筛选，随后提取数据。分别使用Cochrane偏倚风险工具和推荐分级、评估、制定与评价（GRADE）工具评估纳入研究的偏倚风险和证据质量。并且，将对纳入文献中的中药方剂进行基因本体论（GO）和京都基因与基因组百科全书（KEGG）通路富集分析，以找出中医在保胆取石术后预后管理中的有效成分和机制。本研究的分析将使用R 3.5.2软件进行。
共检索到1024篇文章，经过逐步筛选后纳入了9项RCT，涉及926名参与者。所有研究中各重要结局的偏倚风险均为“不确定”。荟萃分析表明，与空白对照相比，中医通过降低复发率、并发症发生率、胆囊壁厚度和胆囊收缩程度来预防胆石症。但是，不良反应发生率无显著差异。GO和KEGG分析结果显示，中医预防胆结石复发的机制可能与胆固醇代谢途径有关，甘草中的柚皮苷可能是预防复发的有效成分。
现有证据表明，使用中医可能会降低保胆取石术后的复发率，且这种效果可能与甘草中的黄酮苷柚皮苷有关，但可能需要更多该领域的高质量RCT才能得出有力结论。
