揭示大柴胡汤在急性胆囊炎中的治疗作用：对其疗效和安全性的全面系统评价与荟萃分析
Unveiling the therapeutic role of Dachaihu decoction in acute cholecystitis: a comprehensive systematic review and meta-analysis of its efficacy and safety.
作者信息
Liu Xin-Xin, Ma Ying-Qi, Kong Ling-Yao, Su You-Zhu, Robinson Nicola, Liu Jian-Ping
机构信息
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
出版信息
Front Pharmacol. 2024 Nov 27;15:1497072. doi: 10.3389/fphar.2024.1497072. eCollection 2024.
BACKGROUND
Dachaihu decoction (Dachaihu tang) plays a crucial role in treating acute illnesses. Recently, a significant number of clinical studies on Dachaihu decoction for acute cholecystitis (AC) have been published. This study was conducted to assess the efficacy and safety of Dachaihu decoction in patients with this condition.
METHODS
To identify relevant randomized controlled trials (RCTs), eight databases and three clinical trial registries were searched from inception to 30 June 2024. Two researchers independently screened and extracted data from eligible studies using EndNote X9 and Microsoft Office Excel 2019. RoB 2.0 was used to assess the risk of bias in the included studies. Stata 17.0 was used for data analysis. Publication bias and its impact on result stability were evaluated using a funnel plot and the "trim-and-fill" method. The quality of evidence was graded using the GRADE assessment system.
RESULTS
Thirty-three RCTs involving 2,851 participants were included. The treatment group demonstrated improved clinical efficacy (RR = 1.18; 95% CI = 1.13 to 1.24), significantly reduced length of hospital stay (MD = -1.78 days; 95% CI = -2.02 to -1.53), and the incidence of adverse events (RR = 0.31; 95% CI = 0.20 to 0.48). Additionally, there appeared to be reductions in the time for abdominal pain to resolve (MD = -1.92 days; 95% CI = -2.33 to -1.51), fever to disappear (MD = -1.52 days; 95% CI = -1.90 to -1.14), white blood cell count to return to normal (MD = -2.89 days; 95% CI = -3.32 to -2.46), alanine aminotransferase (ALT) levels (MD = -11.88 U/L; 95% CI = -15.29 to -8.47), aspartate aminotransferase (AST) levels (MD = -8.74 U/L; 95% CI = -9.76 to -7.72), neutrophil percentage (MD = -9.68; 95% CI = -11.33 to -8.03), TNF-α levels (SMD = -2.10 pg/L; 95% CI = -2.43 to -2.78), and certainty of evidence (moderate-to-low certainty).
CONCLUSION
Dachaihu decoction may be an effective botanical formula for managing AC and a lower incidence of adverse events. However, due to the substantial risk of bias and heterogeneity across the included studies, these findings should be interpreted with caution and require further validation through well-designed, high-quality trials.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=573332.
背景
大柴胡汤在治疗急性疾病中发挥着关键作用。最近，发表了大量关于大柴胡汤治疗急性胆囊炎（AC）的临床研究。本研究旨在评估大柴胡汤治疗该病患者的疗效和安全性。
方法
为识别相关随机对照试验（RCT），检索了8个数据库和3个临床试验注册库，检索时间从创建至2024年6月30日。两名研究人员使用EndNote X9和Microsoft Office Excel 2019独立筛选并从符合条件的研究中提取数据。采用RoB 2.0评估纳入研究的偏倚风险。使用Stata 17.0进行数据分析。采用漏斗图和“修剪填充”法评估发表偏倚及其对结果稳定性的影响。使用GRADE评估系统对证据质量进行分级。
结果
纳入33项RCT，涉及2851名参与者。治疗组临床疗效改善（RR = 1.18；95%CI = 1.13至1.24），住院时间显著缩短（MD = -1.78天；95%CI = -2.02至-1.53），不良事件发生率降低（RR = 0.31；95%CI = 0.20至0.48）。此外，表示腹痛缓解时间（MD = -1.92天；95%CI = -2.33至-1.51）、发热消失时间（MD = -1.52天；95%CI = -1.90至-1.14）、白细胞计数恢复正常时间（MD = -2.89天；95%CI = -3.32至-2.46）、丙氨酸氨基转移酶（ALT）水平（MD = -11.88 U/L；95%CI = -15.29至-8.47）、天冬氨酸氨基转移酶（AST）水平（MD = -8.74 U/L；95%CI = -9.76至-7.72）、中性粒细胞百分比（MD = -9.68；95%CI = -11.33至-8.03）、肿瘤坏死因子-α水平（SMD = -2.10 pg/L；95%CI = -2.43至-2.78）均有下降，证据确定性为中到低确定性。
结论
大柴胡汤可能是治疗急性胆囊炎的有效中药方剂，且不良事件发生率较低。然而，由于纳入研究存在大量偏倚风险和异质性，这些结果应谨慎解读，需要通过设计良好的高质量试验进一步验证。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=573332 。
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