Wu Zihong, Yin Bei, Wang Ziming, Song Enfeng, You Fengming
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
Evid Based Complement Alternat Med. 2023 Jan 30;2023:9731315. doi: 10.1155/2023/9731315. eCollection 2023.
To perform a meta-analysis and network analysis identification to evaluate the efficacy, safety, and potential mechanisms of modified Baitouweng decoction (mBTWD) in the treatment of radiation enteritis.
We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Databases, SionMed, and Chinese Scientific Journals Database to collect the randomized controlled trials (RCTs) of mBTWD treating radiation enteritis. Rev.Man 5.3 and Stata 14.0 software are employed for meta-analysis. The GRADE online tool is used to evaluate the quality of evidence. Network analysis and molecular docking approach are applied to predict the potential targets and ingredients of representative drugs in mBTWD for the treatment of radiation enteritis.
Seventeen studies are eventually included, covering a total of 1611 patients: (1) The clinical efficacy is significantly higher in mBTWD groups than in control groups (RR = 1.24, 95% CI (1.17, 1.32), < 0.00001). (2) mBTWD has certain advantages in improving TCM syndromes (MD = -3.41, < 0.00001). (3) mBTWD has a certain positive effect on the improvement of intestinal signs and symptoms (RR = 1.23, =0.0001; OR = 3.51, < 0.00001). (4) Indexes including CRP, KPS, and OB, are better in mBTWD groups than in control groups ( < 0.00001, =0.002, =0.03), but the credibility is downgraded for a small sample size. Adverse events and recurrence rates require further confirmation with larger sample sizes. (5) Univariate meta-regression for clinical efficacy shows none of the coefficients are significantly associated with the estimated risk ratio. The clinical efficacy overestimates about 4.9% from publication bias. The quality of the included studies is low according to GRADE evidence. (6) Quercetin, isorhamnetin, and beta-sitosterol are the main ingredients from representative drugs in mBTWD and its key targets are MYC, TP53, and MAPK14/MAPK1.
mBTWD may be effective in the treatment of radiation enteritis, but its long-term benefits, safety, and molecular mechanisms remain unclear due to the poor quality of the evidence. Larger sample sizes, high-quality studies, and basic research are essential in the future.
进行荟萃分析和网络分析鉴定，以评估改良白头翁汤（mBTWD）治疗放射性肠炎的疗效、安全性及潜在机制。
检索PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、万方数据库、世行医学数据库和中国科学期刊数据库，收集mBTWD治疗放射性肠炎的随机对照试验（RCT）。采用Rev.Man 5.3和Stata 14.0软件进行荟萃分析。使用GRADE在线工具评估证据质量。应用网络分析和分子对接方法预测mBTWD中代表性药物治疗放射性肠炎的潜在靶点和成分。
最终纳入17项研究，共涉及1611例患者：（1）mBTWD组的临床疗效显著高于对照组（RR = 1.24，95%CI（1.17，1.32），P < 0.00001）。（2）mBTWD在改善中医证候方面具有一定优势（MD = -3.41，P < 0.00001）。（3）mBTWD对改善肠道体征和症状有一定积极作用（RR = 1.23，P = 0.0001；OR = 3.51，P < 0.00001）。（4）包括CRP、KPS和OB在内的指标，mBTWD组优于对照组（P < 0.00001，P = 0.002，P = 0.03），但因样本量小，可信度降低。不良事件和复发率需要更大样本量进一步证实。（5）临床疗效的单因素meta回归显示，各系数均与估计风险比无显著相关性。由于发表偏倚，临床疗效高估约4.9%。根据GRADE证据，纳入研究的质量较低。（6）槲皮素、异鼠李素和β-谷甾醇是mBTWD中代表性药物的主要成分，其关键靶点为MYC、TP53和MAPK14/MAPK1。
mBTWD可能对放射性肠炎有效，但由于证据质量差，其长期效益、安全性和分子机制仍不明确。未来需要更大样本量、高质量的研究和基础研究。
