Zhu Jia-Xu, Yu Bin-Yang, Li Xian, Gao Rui
Graduate School, China Academy of Chinese Medical Sciences Beijing 100700, China.
Graduate School, Beijing University of Chinese Medicine Beijing 100029, China.
Zhongguo Zhong Yao Za Zhi. 2024 Sep;49(17):4786-4800. doi: 10.19540/j.cnki.cjcmm.20240523.501.
The effectiveness and safety of various oral Chinese patent medicines combined with conventional western medicine in treatment of gastro-esophageal reflux disease(GERD) were evaluated using network Meta-analysis. CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science were searched for randomized controlled trial(RCT) of oral Chinese patent medicines combined with conventional western medicine in treatment of GERD from inception to September 2023. The quality of the included studies was assessed using the Cochrane risk-of-bias tool, and data analysis was conducted using RevMan 5.4 and Stata 16 software. Forty-seven RCTs were included, involving 10 oral Chinese patent medicines, including Jianwei Yuyang Tablets, Qizhi Weitong Granules, Dalitong Granules, Liuwei Anxiao Capsules, Kangfuxin Liquid, Weisu Granules, Zhizhu Kuanzhong Capsules, Xiaochaihu Granules, Xiaoyao Pills, and Danweikang Capsules. Network Meta-analysis showed that:(1)in terms of effective rate of clinical symptoms, intervention measure ranked first by SUCRA was Dalitong Granules + conventional western medicine.(2)In terms of endoscopic effective rate, intervention measure ranked first by SUCRA was Liuwei Anxiao Capsules + conventional western medicine.(3)In terms of increasing serum gastrin levels, intervention measure ranked first by SUCRA was Weisu Granules + conventional western medicine.(4)In terms of increasing plasma motilin level, intervention measure ranked first by SUCRA was Xiaoyao Pills + conventional western medicine. In terms of symptom scores, quality of life and recurrence rate, only descriptive analyses were performed due to the heterogeneity of the studies, but all studies reported that oral Chinese patent medicines combined with conventional western medicine improved the outcome indicators better than conventional western medicine alone, and the differences were statistically significant. In terms of adverse reactions, there was no significant difference between oral Chinese patent medicine combined with conventional western medicine and conventional western medicine alone. Through cluster analysis, it was found that the comprehensive efficacy of Dalitong Granules + conventional western medicine, Danweikang Capsules + conventional western medicine, Qizhi Weitong Granules + conventional western medicine, Kangfuxin Liquid + conventional western medicine, and Liuwei Anxiao Capsules + conventional western medicine were more prominent, and could improve clinical symptoms and endoscopic inflammation at the same time. The results indicated that oral Chinese patent medicines combined with conventional western medicine in treatment of GERD could improve comprehensive efficacy, alleviate clinical symptoms, and regulate gastrointestinal motility. However, due to limitations such as sample size and quality of the included literature, the conclusions need to be further verified by more large-sample, high-quality studies.
采用网状Meta分析评价多种口服中成药联合传统西药治疗胃食管反流病（GERD）的有效性和安全性。检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、考克兰图书馆、EMbase和Web of Science，查找从建库至2023年9月口服中成药联合传统西药治疗GERD的随机对照试验（RCT）。采用Cochrane偏倚风险工具评估纳入研究的质量，使用RevMan 5.4和Stata 16软件进行数据分析。共纳入47项RCT，涉及10种口服中成药，包括健胃愈疡片、气滞胃痛颗粒、达立通颗粒、六味安消胶囊、康复新液、维U颠茄铝胶囊、枳术宽中胶囊、小柴胡颗粒、逍遥丸和丹桂香胶囊。网状Meta分析结果显示：（1）在临床症状有效率方面，累积排序曲线下面积（SUCRA）排序第一的干预措施是达立通颗粒+传统西药。（2）在内镜有效率方面，SUCRA排序第一的干预措施是六味安消胶囊+传统西药。（3）在提高血清胃泌素水平方面，SUCRA排序第一的干预措施是维U颠茄铝胶囊+传统西药。（4）在提高血浆胃动素水平方面，SUCRA排序第一的干预措施是逍遥丸+传统西药。在症状评分、生活质量和复发率方面，由于研究存在异质性，仅进行了描述性分析，但所有研究均报告口服中成药联合传统西药比单纯传统西药能更好地改善结局指标，差异有统计学意义。在不良反应方面，口服中成药联合传统西药与单纯传统西药之间无显著差异。通过聚类分析发现，达立通颗粒+传统西药、丹桂香胶囊+传统西药、气滞胃痛颗粒+传统西药、康复新液+传统西药、六味安消胶囊+传统西药的综合疗效更突出，能同时改善临床症状和内镜下炎症。结果表明，口服中成药联合传统西药治疗GERD可提高综合疗效，缓解临床症状，调节胃肠动力。然而，由于纳入文献的样本量和质量等局限性，结论需要更多大样本、高质量研究进一步验证。
