基于贝叶斯网络的中药方剂治疗幽门螺杆菌阳性消化性溃疡的证据构建：Meta 分析。
Evidence construction of Chinese herbal formulae for the treatment of H. pylori positive peptic ulcer: A Bayesian network Meta-analysis.
机构信息
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China; School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China.
College of Pharmacy, Anhui University of Chinese Medicine, 230012 Hefei, China; Yangtze Delta Drug Advanced Research Institute, 226100, Nantong, China.
出版信息
Phytomedicine. 2022 Oct;105:154327. doi: 10.1016/j.phymed.2022.154327. Epub 2022 Jul 17.
PURPOSE
Helicobacter pylori (H. pylori) positive peptic ulcer disease (PUD) is a highly prevalent digestive disease with serious consequences of poor prognosis without rational medical intervention. Apparent advantages of Chinese herbal formulae application in PUDs have been appreciated by clinical practitioners recently in China. However, there is no enough viewpoint of evidence-based medicine for them to reach a broad consensus at the more favorable formulae. Therefore, we adopted the method of Bayesian network Meta-analysis (BNMA) in order to get a solution.
METHOD
Literature retrieval of clinical randomized controlled trials (RCTs) was conducted with eight databases of PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, the VIP medicine information system, the Wanfang Data Knowledge Service Platform and Chinese Biomedical Literature Service System. Review Manager 5.4 software, R project 4.1.1 software and STATA16.0 software were used to carry out this BNMA. The primary outcome indicator is H. pylori eradicated rate. The secondary outcome indicator is clinical effectiveness rate, recurrence rate and adverse reaction report.
RESULT
A total of fifty-one RCTs involving 5172 patients and ten therapeutic strategies were included in this BNMA. The results showed that supplementation with Chinese herbal formulae significantly improved the eradication rate, clinical efficiency and reduced recurrence rate of H. pylori compared with the single conventional triple therapy (CON) group in a relatively safe manner. Comprehensive therapeutic efficacy analysis of H. pylori eradicated rate and clinical effectiveness rate showed that CON combined with Xiangsha Liujunzi decoction (XSD) manifests at the first grade among these ten therapeutic strategies.
CONCLUSION
The efficacy and safety of Chinese herbal formulae and conventional triple therapy were validated by this BNMA. CON+XSD appears to be the most satisfactory therapeutic strategy for H. pylori-positive PUD, reminding clinicians of the potential value of the combination of Chinese herbal formulae and conventional chemotherapy.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021268574.
目的
幽门螺杆菌（H. pylori）阳性消化性溃疡（PUD）是一种高发的消化系统疾病，如果没有合理的医学干预，其预后较差。最近，中国临床医生对中药方剂在 PUD 中的应用优势有了明显的认识。然而，由于缺乏足够的循证医学观点，对于更有利的方剂，尚未达成广泛共识。因此，我们采用贝叶斯网状 Meta 分析（BNMA）的方法来解决这个问题。
方法
我们对 PubMed、Embase、Cochrane 图书馆、Web of Science、中国知网、维普医药信息系统、万方数据知识服务平台和中国生物医学文献服务系统这 8 个数据库进行了临床随机对照试验（RCT）的文献检索。使用 Review Manager 5.4 软件、R 项目 4.1.1 软件和 STATA16.0 软件进行了这项 BNMA。主要结局指标是 H. pylori 根除率。次要结局指标是临床有效率、复发率和不良反应报告。
结果
本 BNMA 共纳入 51 项 RCT，涉及 5172 例患者和 10 种治疗策略。结果表明，与单一常规三联疗法（CON）组相比，中药方剂联合治疗在相对安全的情况下显著提高了 H. pylori 的根除率、临床疗效和降低了复发率。H. pylori 根除率和临床有效率的综合疗效分析表明，在这 10 种治疗策略中，CON 联合香砂六君子汤（XSD）表现为一级。
结论
本 BNMA 验证了中药方剂和常规三联疗法的疗效和安全性。CON+XSD 似乎是治疗 H. pylori 阳性 PUD 最令人满意的治疗策略，提醒临床医生注意中药方剂与常规化疗联合的潜在价值。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD42021268574。
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