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中西医结合治疗重型肝炎的荟萃分析

作者：王笑梅王宪波刘慧敏

单位：首都医科大学附属北京地坛医院北京 100015

关键词：重型肝炎肝衰竭荟萃分析中西医结合

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出版年,卷(期):页码：2013,5(4):10-15

摘要：

摘要：目的回顾性评价中西医结合治疗重型肝炎的疗效。方法以“重型肝炎”、“肝衰竭”、“中医”和“中西医结合”为检索词，计算机检索中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库-维普资讯、PubMed、万方数据知识平台中有关中西医结合治疗重型肝炎的随机对照临床研究，采用Stata 9.0软件进行荟萃分析。结果依据入选标准，共17篇文献1492例患者的临床资料纳入荟萃分析，结果显示与单纯西医治疗组相比，治疗4周，中西医结合治疗组ALT下降程度（350 U/L）高于西医组（315 U/L），SMD值为－0.71，95%CI －1.16～－0.25，P ＜ 0.01；总胆红素下降程度（225 μmol/L）高于西医组（147 μmol/L），SMD值为－0.88， 95%CI －1.11～－0.65，P ＜ 0.01；PTA的上升水平（39.28%）高于西医组（20.96%），SMD值为1.19，95%CI 0.77～1.61，P ＜ 0.01。中西医结合治疗组有效率（77.0%）高于西医组（53.7%），有效率相对危险度（RR）值为1.41，95%CI 1.31～1.52；P ＜ 0.01；单纯西医治疗组病死率平均为40.7%，中西医结合治疗组的病死率平均为22.4%， RR值为1.84，95%CI 1.50～2.26，P ＜ 0.01，提示中西医结合治疗降低了患者的病死率。结论中西医结合治疗重型肝炎，在降低病死率和改善肝功能等方面具有一定的优势。

Abstract: Objective A meta-analysis was conducted to evaluate the efficacy of integrated traditional Chinese and Western medicine in the treatment of severe hepatitis. Methods Medical database including CNKI, CBM, Chinese scientific periodical full text database, Pubmed and Wanfang data were searched about treatment of severe hepatitis by the integrated Chinese and Western medicine, randomized controlled clinical trials (RCTs) comparing integrated Chinese and Western medicine with conventional Western medicine were screened out from the searched literatures, Stata 9.0 was used for the meta-analysis. The analysis included the calculation of standardized mean difference (SMD) for measurement data and odds ratio (OR) for enumeration data. Results Seventeen RCTs including 1492 cases were enrolled for analysis according to the eligibility and exclusion criteria. Compared to conventional Western treatment alone, the results of integrated traditional Chinese medicine and Western medicine treatment showed as follows: Decline of ALT in integrated treatment group (350 U/L) is grater than that in Western medicine group (315 U/L), SMD = －0.71, 95%CI －1.16-－0.25, P ＜ 0.01. Decline of TBil in integrated treatment group (225 μmol/L) is grater than that in Western medicine group (147 μmol/L), SMD = －0.88, 95%CI －1.11-－0.65, P ＜ 0.01. Improvement of PTA in integrated treatment group (39.28%) is grater than that in Western medicine group (20.96%), SMD = 1.19, 95%CI 0.77-1.61, P ＜ 0.01. The efficacy rate in integrated treatment group (77.0%) is higher than that in Western medicine group (53.7%), RR = 1.41, 95%CI 1.31-1.52; P ＜ 0.01. Mortality rate in integrated treatment group (22.4%) is lower than that in Western medicine group (40.7%), RR = 1.84, 95%CI 1.50-2.26, P ＜ 0.01. Conclusions The decline of ALT and total bilirubin as well as the improvement of PTA is more remarkable in the group of integrated Chinese and Western medicine, the mortality rate is lower in the group of integrated Chinese and Western medicine to treat severe hepatitis. The association of traditional Chinese medicine with Western medicine therapy is superior to Western medicine therapy alone in the treatment of severe hepatitis.

基金项目：

国家“十一五”科技重大专项（2008ZX10005-007）；国家中医药管理局中医药科技研究专项（06-07LB01）；首都医学发展基金（SF-2007-Ⅲ-03）

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