Huang Meilan, Luo Shiman, Yang Jiayue, Xiong Huiling, Lu Xiaohua, Ma Xiao, Zeng Jinhao, Efferth Thomas
Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China.
School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China.
EXCLI J. 2024 Sep 6;23:1185-1207. doi: 10.17179/excli2024-7618. eCollection 2024.
Chronic atrophic gastritis (CAG) is considered as a significant risk factor for triggering gastric cancer incidence, if not effectively treated. decoction (SD) is a well-known classic formula for treating gastric disorders, and -similar formulae (SF) derived from SD have also been highly regarded by Chinese clinical practitioners for their effectiveness in treating chronic atrophic gastritis. Currently, there is a lack of meta-analysis for these formulae, leaving unclear which exhibits optimal efficacy. Therefore, we employed Bayesian network meta-analysis (BNMA) to evaluate the efficacy and safety of SF as an intervention for CAG and to establish a scientific foundation for the clinical utilization of SF. The result of meta-analysis demonstrated that the combination of SF and basic therapy outperformed basic therapy alone in terms of clinical efficacy rate, eradication rate of H. pylori, and incidence of adverse events. As indicated by the SUCRA value, decoction (CLD) demonstrated superior efficacy in enhancing clinical effectiveness and ameliorating infection, and it also showed remarkable effectiveness in minimizing the occurrence of adverse events. Comprehensive analysis of therapeutic efficacy suggests that CLD is most likely the optimal choice among these six formulations, holding potential value for optimizing clinical treatment strategies. See also the graphical abstract(Fig. 1).
慢性萎缩性胃炎(CAG)若未得到有效治疗,被认为是引发胃癌的一个重要风险因素。四君子汤(SD)是治疗胃部疾病的著名经典方剂,从四君子汤衍生而来的类方(SF)因其在治疗慢性萎缩性胃炎方面的有效性,也受到中国临床医生的高度重视。目前,对于这些方剂缺乏荟萃分析,尚不清楚哪种方剂疗效最佳。因此,我们采用贝叶斯网络荟萃分析(BNMA)来评估类方作为慢性萎缩性胃炎干预措施的疗效和安全性,并为类方的临床应用建立科学依据。荟萃分析结果表明,类方与基础治疗联合应用在临床有效率、幽门螺杆菌根除率和不良事件发生率方面均优于单纯基础治疗。根据累积排序曲线下面积(SUCRA)值,柴苓汤(CLD)在提高临床疗效和改善幽门螺杆菌感染方面显示出卓越疗效,在减少不良事件发生方面也表现出显著效果。对治疗效果的综合分析表明,柴苓汤很可能是这六种方剂中的最佳选择,对优化临床治疗策略具有潜在价值。另见图1(图形摘要)。