枫蓼肠胃康制剂治疗急性胃肠炎有效性及安全性的系统评价与Meta分析Systematic review and Meta-analysis of efficacy and safety of Fengliao Changweikang prescription in treatment of acute gastroenteritis
李苗苗,赵晖,张乐,戴泽琦,吴雪,唐旭东,廖星
LI Miao-miao,ZHAO Hui,ZHANG Le,DAI Ze-qi,WU Xue,TANG Xu-dong,LIAO Xing
摘要(Abstract):
该研究系统评价枫蓼肠胃康制剂治疗急性胃肠炎(acute gastroenteritis, AGE)的临床有效性及安全性。计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、Medline、Cochrane Library,以及2个临床试验注册平台,搜集枫蓼肠胃康制剂治疗AGE的随机对照试验(randomized controlled trial, RCT),检索时间从建库至2022年8月30日。按照预先制定的纳入、排除标准独立进行文献筛选、资料提取、偏倚风险评估后,采用RevMan 5.4.1软件进行数据分析。最终纳入18项RCTs, 3 489例患者。Meta分析显示,单用枫蓼肠胃康制剂可提高腹痛缓解率(RR=1.27,95%CI[1.17,1.38],P<0.000 01);枫蓼肠胃康制剂+常规西药可提高治愈率(RR=1.43,95%CI[1.12,1.82],P=0.004),缩短腹泻改善时间(RR=-1.65,95%CI[-2.44,-0.86],P<0.000 1)、腹痛改善时间(RR=-1.46,95%CI[-2.00,-0.92],P<0.000 01)、呕吐改善时间(RR=-2.16,95%CI[-2.51,-1.81],P<0.000 01)和发热改善时间(RR=-2.61,95%CI[-4.00,-1.23],P=0.000 2),降低白细胞介素-8(IL-8)(RR=-1.07,95%CI[-1.26,-0.88],P<0.000 01)、白细胞介素-6(IL-6)(RR=-8.24,95%CI[-8.99,-7.49],P<0.000 01)和超敏C反应蛋白(hs-CRP)(RR=-3.04,95%CI[-3.40,-2.69],P<0.000 01)水平,减少疾病的复发率(RR=0.20,95%CI[0.05,0.90],P<0.04)。综合结果,枫蓼肠胃康制剂临床应用安全性较好,有益于AGE患者腹痛、腹泻、呕吐和发热等临床症状的改善以及部分血清炎症因子水平的降低。然而考虑到目前评估枫蓼肠胃康制剂在AGE患者中有效性和安全性的高质量研究较少,未来还需进一步的证据。
This study systematically evaluated the clinical efficacy and safety of Fengliao Changweikang prescription for treating acute gastroenteritis(AGE). The databases of CNKI, Wanfang, VIP, SinoMed, Medline, Cochrane Library and two clinical trial registration platforms were retrieved from inception to August 30, 2022, to collect randomized controlled trial(RCT) on Fengliao Changweikang prescription treating AGE. Two researchers independently conducted literature screening, data extraction, and risk of bias assessment according to pre-established inclusion and exclusion criteria. RevMan 5.4.1 was used for data analysis. Finally, 18 RCTs were included, involving 3 489 patients. Meta-analysis showed that compared with conventional western medicine, Fengliao Changweikang prescription improved the relief rate of abdominal pain(RR=1.27, 95%CI[1.17, 1.38],P<0.000 01); Fengliao Changweikang prescription + conventional western medicine increased the cure rate(RR=1.43, 95%CI[1.12, 1.82], P=0.004), shortened the duration of diarrhoea(RR=-1.65, 95%CI[-2.44,-0.86], P<0.000 1), abdominal pain(RR=-1.46, 95%CI[-2.00,-0.92], P<0.000 01), vomiting(RR=-2.16, 95%CI[-2.51,-1.81], P<0.000 01) and fever(RR=-2.61, 95%CI[-4.00,-1.23], P=0.000 2), down-regulated the level of interleukin-8(IL-8)(RR=-1.07, 95%CI[-1.26,-0.88], P<0.000 01), IL-6(RR=-8.24, 95%CI[-8.99,-7.49], P<0.000 01) and hypersensitive C-reactive protein(hs-CRP)(RR=-3.04, 95%CI[-3.40,-2.69], P<0.000 01) and recurrence of AGE(RR=0.20, 95%CI[0.05, 0.90], P<0.04). In conclusion, Fengliao Changweikang prescription was safe in clinical application. It was beneficial to alleviate the clinical symptoms of diarrhea, abdominal pain, vomiting, and fever, and down-regulate the levels of some serum inflammatory factors in AGE patients. However, considering that few high-quality studies have evaluated the efficacy and safety of Fengliao Changweikang prescription in treatment of AGE, further evidence is needed in the future.
关键词(KeyWords):
枫蓼肠胃康制剂;急性胃肠炎;随机对照试验;系统评价;Meta分析
Fengliao Changweikang prescription;acute gastroenteritis;randomized controlled trial;systematic review;Meta-analysis
基金项目(Foundation): 国家自然科学基金项目(82174239);; 中国中医科学院科技创新工程项目(CI2021A00701-3,CI2021A05503);中国中医科学院基本科研业务优秀青年科技人才(创新类)培养专项(ZZ13-YQ-075);; 中国中医药循证医学中心“业务研究室主任专项”(2020YJSZX-2)
作者(Author):
李苗苗,赵晖,张乐,戴泽琦,吴雪,唐旭东,廖星
LI Miao-miao,ZHAO Hui,ZHANG Le,DAI Ze-qi,WU Xue,TANG Xu-dong,LIAO Xing
DOI: 10.19540/j.cnki.cjcmm.20221121.501
参考文献(References):
- [1] FUNK A,SCHNADOWER D,FREEDMAN S B.Update on nonantibiotic therapies for acute gastroenteritis[J].Curr Opin Infect Dis,2020,33(5):381.
- [2] HALL A J,WIKSWO M E,MANIKONDA K,et al.Acute gastroenteritis surveillance through the national outbreak reporting system,united states[J].Emerg Infect Dis,2013,19(8):1305.
- [3] World Health Organization.The treatment of diarrhoea:a manual for physicians and other senior health workers[M].4th ed.Geneva:World Health Organization Press,2005.
- [4] JAGAI J S,GRIFFITHS J K,KIRSHEN P K,et al.Seasonal patterns of gastrointestinal illness and streamflow along the Ohio River[J].Int J Environ Res Public Health,2012,9(5):1771.
- [5] PATEL M M,WIDDOWSON M A,GLASS R I,et al.Systema-tic literature review of role of noroviruses in sporadic gastroenteritis[J].Emerg Infect Dis,2008,14(8):1224.
- [6] SINGH M,SANKAR J,KUMAR A,et al.Predictors of mortality in children admitted to the pediatric intensive care unit with acute gastroenteritis with severe dehydration[J].Indian J Pediatr,2019,86(12):1142.
- [7] LIU L,OZA S,HOGAN D,et al.Global,regional,and natio-nal causes of child mortality in 2000-13,with projections to inform post-2015 priorities:an updated systematic analysis[J].Lancet,2015,385(6):430.
- [8] SAZAWAL S,HIREMATH G,DHINGRA U,et al.Efficacy of probiotics in prevention of acute diarrhoea:a Meta-analysis of masked,randomised,placebo-controlled trials[J].Lancet Infect Dis,2006,6(6):374.
- [9] WHYTE L A,AL-ARAJI R A,MCLOUGHLIN L M.Guidelines for the management of acute gastroenteritis in children in Europe[J].Arch Dis Child Educ Pract Ed,2015,100(6):308.
- [10] 何丽,李红,潘妍,等.葛根芩连汤加减联合中药热奄包治疗急性肠胃炎临床疗效及对血清PCT、hs-CRP、IL-6水平的影响[J].四川中医,2021,39(12):106.
- [11] 潘文娟,田伟珍,王立明.2016—2020年我院消化科口服中成药使用调查分析[J].中医药管理杂志,2021,29(16):58.
- [12] 马艳.藿香正气口服液合诺氟沙星治疗AGE分析[J].中国中医药现代远程教育,2018,16(8):107.
- [13] 李燕君.枫蓼肠胃康胶囊联合常规三联治疗慢性萎缩性胃炎伴肠上皮化生的效果[J].中国医学创新,2020,17(19):149.
- [14] 李赛莲,许保,陈正义,等.枫蓼肠胃康胶囊联合多潘立酮治疗慢性萎缩性胃炎伴肠上皮化生的临床研究[J].中国中西医结合消化杂志,2018,26(11):907.
- [15] 闫雨蒙,杨小静,赵春霞,等.连花清瘟制剂联合磷酸奥司他韦治疗流行性感冒的系统评价与Meta分析[J].中国中药杂志,2022,47(15):4238.
- [16] 王自强,吕健,厉将斌,等.宁泌泰胶囊治疗泌尿系感染有效性与安全性的系统评价与Meta分析[J].中国中药杂志,2022,47(13):3648.
- [17] PAGE M J,MCKENZIE J E,BOSSUYT P M,et al.The PRISMA 2020 statement:an updated guideline for reporting systema-tic reviews[J].Br Med J,2021,372:n71.
- [18] 陈赐琴.阿奇霉素联合枫蓼肠胃康治疗急性肠炎的疗效分析[J].海峡药学,2021,33(12):190.
- [19] 李梅,薛梅苓.阿奇霉素联合枫蓼肠胃康治疗急性肠炎的临床效果[J].临床医学研究与实践,2019,4(3):27.
- [20] 李建芝,高鹏.枫蓼肠胃康片联合奥美拉唑和复方嗜酸乳杆菌治疗急性胃肠炎的临床研究[J].现代药物与临床,2016,31(8):1201.
- [21] 侯允孝.枫蓼肠胃康颗粒治疗儿童急性肠胃炎所致腹痛1 080例[J].江苏中医药,2004,25(4):33.
- [22] 陆艳.胃复安联用枫蓼肠胃康片治疗急性胃炎的临床疗效观察[J].哈尔滨医药,2013,33(4):287.
- [23] 杨文.枫蓼肠胃康联合诺氟沙星治疗急性胃肠炎的临床观察[J].临床合理用药杂志,2014,7(35):8.
- [24] 成永,廉云华,陈娟.枫蓼肠胃康颗粒治疗儿童急性肠胃炎所致腹痛104例观察[J].亚太传统医药,2014,10(21):105.
- [25] 王家茂,谭自平.阿奇霉素配合枫蓼肠胃康胶囊治疗急性肠炎的临床观察[J].基层医学论坛,2014,18(10):1293.
- [26] 李怀庆.用枫蓼肠胃康颗粒剂治疗急性肠炎的效果观察[J].当代医药论丛,2015,13(22):278.
- [27] 李保华.阿奇霉素联合枫蓼肠胃康治疗急性肠炎的临床效果观察[J].中外医学研究,2016,14(10):119.
- [28] 薛微.枫蓼肠胃康分散片对急性胃肠炎的治疗作用研究[J].临床医药文献电子杂志,2019,6(80):158.
- [29] 高才良.研究蒙脱石散联合枫蓼肠胃康胶囊治疗急性肠炎的临床效果[J].世界最新医学信息文摘,2017,17(17):124.
- [30] 陈松国.观察蒙脱石散与枫蓼肠胃康应用于急性肠炎治疗的临床效果[J].世界最新医学信息文摘,2018,18(74):117.
- [31] 朱玉霞,董静,管丽君,等.消旋卡多曲颗粒联合枫蓼肠胃康颗粒治疗小儿腹泻的效果及对IL-6、IL-8及TNF-α水平的影响[J].现代实用医学,2019,31(12):1591.
- [32] 章欣,金礼通,夏哲林.枫蓼肠胃康联合间苯三酚治疗急性胃肠炎痉挛性腹痛效果观察[J].中国乡村医药,2019,26(18):39.
- [33] 邬小娟,李结实,柯晓.枫蓼肠胃康片联合法莫替丁治疗急性胃肠炎临床研究[J].新中医,2022,54(5):101.
- [34] 余艳妹.枫蓼肠胃康胶囊辅助治疗小儿感染性腹泻效果观察[J].中国乡村医药,2021,28(2):20.
- [35] 翟瑞琴,于静,高若飞,等.枫蓼肠胃康配合西咪替丁联合干扰素及补锌综合治疗小儿轮状病毒感染性腹泻的安全性及有效性研究[J].中国药物滥用防治杂志,2021,27(6):929.
- [36] KIM Y J,PARK K H,PARK D A.Guideline for the antibiotic use in acute gastroenteritis[J].Infect Chemother,2019,51(2):217.
- [37] 林思敏,罗玉婷,陈捷,等.消旋卡多曲辅助治疗小儿急性胃肠炎的价值研究[J].中国现代药物应用,2021,15(16):119.
- [38] 路元芳.枫蓼肠胃康颗粒在儿科临床的应用观察[J].中国实用医药,2011,6(21):55.
- [39] 卢丽珠,俞进.枫蓼肠胃康胶囊抗腹泻作用的实验研究[J].中国中医药科技,2014,21(5):499.
- [40] 缪一舟,张骏,吴晓玮.静脉滴注阿奇霉素的不良反应影响因素分析[J].中国处方药,2021,19(11):93.
- [41] 方思晓,王一博.儿科阿奇霉素临床用药合理性调查研究[J].中国药物滥用防治杂志,2021,27(5):737.
- [42] 李夏,李博,王天园,等.疏血通注射液治疗糖尿病周围神经病变有效性和安全性的系统评价与Meta分析[J].中国中药杂志,2022,47(11):3088.
- [43] 杨硕,吕健,王连心,等.冰黄肤乐软膏治疗湿疹有效性和安全性的系统评价与Meta分析[J].中国中药杂志,2022,47(10):2802.
- [44] 刘建平,曹卉娟.从循证医学看国内发表的中医药临床研究现状及改进策略[J].中国中西医结合杂志,2010,30(1):5.
- [45] 李洪峥,李博,赵国桢.中医药临床试验过程中随机化的实现方法及改进思考[J].中国新药杂志,2019,28(11):1348.
- [46] 成冯镜茗,吕健,谢雁鸣.肝爽颗粒治疗肝损伤有效性和安全性的系统评价与Meta分析[J].中国中药杂志,2022,47(21):5944.
- [47] 谭畅,张利丹,支英杰,等.鼻渊通窍颗粒治疗慢性鼻窦炎有效性和安全性的系统评价与Meta分析[J].中国中药杂志,2022,47(16):4489.
- [48] SCHULZ K F,ALTMAN D G,DAVID M.CONSORT 2010 statement:updated guidelines for reporting parallel group randomised trials[J].Br Med J,2010,1(2):100.
- [49] 曾于珍,陈世耀.临床研究结局指标选择与样本量估计[J].协和医学杂志,2018,9(1):87.
- 枫蓼肠胃康制剂
- 急性胃肠炎
- 随机对照试验
- 系统评价
- Meta分析
Fengliao Changweikang prescription - acute gastroenteritis
- randomized controlled trial
- systematic review
- Meta-analysis