Chen Qian, Xiao Zheng, He Qing-Ying, Zhang Rui-Rong, Chen Shu-Xian, Dong Jia-Wei, Zhang Hua, Chen Xiao-Fan
Evidence-Based Medicine Research Centre, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China.
Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Front Pharmacol. 2022 Sep 14;13:938932. doi: 10.3389/fphar.2022.938932. eCollection 2022.
Diarrhea is one of the leading causes of death worldwide and is associated with immune dysfunction. The modulatory effects of Shenling Baizhu powder (SLBZS) on immune function in diarrheal disease have been validated in various animal models. However, the results of these studies have not been systematically evaluated. This study aimed to evaluate the preclinical data on SLBZS for the treatment of diarrhea from an immunological perspective. PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, VIP, and Chinese Medicine Database were searched for all animal trials on SLBZS for the treatment of diarrhea published up to April 2022. Standardized mean differences (SMD) were used as effect sizes in the meta-analysis of continuous variables, including immune organs, immune cells, and immune cytokines. Subgroup analysis was performed according to animal species and disease models. The GRADE was used to assess the quality of evidence. A total of 26 studies were included. Meta-analysis showed that compared to those in the model group, SLBZS significantly increased body weight [SMD = 1.54, 95% confidence interval (CI) (1.06, 2.02)], spleen mass [SMD = 1.42, 95% CI (0.98, 1.87)], thymus mass [SMD = 1.11, 95% CI (0.69, 1.53)], macrophage phagocytic capacity (SMD = 1.07, 95% CI [0.59, 1.54]), sIgA [SMD = 1.04, 95% CI (0.33, 1.74)], RBC-C3b-RR [SMD = 1.16, 95% CI (0.65, 1.67)], IL-2 [SMD = 1.52, 95% CI (0.89, 2.14)] and decreased diarrhea scores [SMD = -1.40, 95% CI (-2.03, -0.87)], RBC-IC-RR [SMD = -1.40, 95% CI (-1.94, -0.87)], and IL-8 [SMD = -2.80, 95% CI (-3.54, -2.07)]. Subgroup analysis showed that SLBZS regulated TNF-α, IL-1β, and IL-10 in rats and mice, and improved IL-6 and IL-10 in different diseases, with differences between subgroups ( < 0.05). Owing to heterogeneity, the reliability of the results remains to be verified. The quality of evidence was "very low". SLBZS improve diarrhea symptoms by enhancing immune function. It has curative effects with differences between different species and diseases, however, because the reporting in the original studies was too unclear to be assessed, the analysis was inconclusive. For higher quality evidences, future research should pay attention to the scientific rigor of the experimental design and the completeness of the reported results.
腹泻是全球主要死因之一，且与免疫功能障碍相关。参苓白术散（SLBZS）对腹泻性疾病免疫功能的调节作用已在多种动物模型中得到验证。然而，这些研究结果尚未得到系统评价。本研究旨在从免疫学角度评估SLBZS治疗腹泻的临床前数据。检索了PubMed、Embase、Cochrane图书馆、中国知网、万方数据库、维普数据库和中医药数据库，查找截至2022年4月发表的所有关于SLBZS治疗腹泻的动物试验。标准化均数差（SMD）用作连续变量荟萃分析中的效应量，这些连续变量包括免疫器官、免疫细胞和免疫细胞因子。根据动物种类和疾病模型进行亚组分析。采用GRADE评估证据质量。共纳入26项研究。荟萃分析表明，与模型组相比，SLBZS显著增加体重[SMD = 1.54，95%置信区间（CI）（1.06，2.02）]、脾脏重量[SMD = 1.42，95% CI（0.98，1.87）]、胸腺重量[SMD = 1.11，95% CI（0.69，1.53）]、巨噬细胞吞噬能力（SMD = 1.07，95% CI [0.59，1.54]）、分泌型免疫球蛋白A（sIgA）[SMD = 1.04，95% CI（0.33，1.74）]、红细胞C3b受体花环率（RBC-C3b-RR）[SMD = 1.16，95% CI（0.65，1.67）]、白细胞介素-2（IL-2）[SMD = 1.52，95% CI（0.89，2.14）]，并降低腹泻评分[SMD = -1.40，95% CI（-2.03，-0.87）]、红细胞免疫复合物花环率（RBC-IC-RR）[SMD = -1.来40，95% CI（-1.94，-0.87）]和白细胞介素-8（IL-8）[SMD = -2.80，95% CI（-3.54，-2.07）]。亚组分析表明，SLBZS在大鼠和小鼠中调节肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-10（IL-10），并在不同疾病中改善白细胞介素-6（IL-6）和白细胞介素-10，亚组间存在差异（<0.05）。由于存在异质性，结果的可靠性仍有待验证。证据质量为“极低”。SLBZS通过增强免疫功能改善腹泻症状。它在不同物种和疾病中具有疗效差异，然而，由于原始研究中的报告过于不清楚而无法评估，分析结果尚无定论。为了获得更高质量的证据，未来的研究应注重实验设计的科学严谨性和报告结果的完整性。
