Efficacy and safety of integrated umbilical compress therapy and enema treatment for liver cirrhosis:a Meta-analysis
-
摘要: [目的]系统评价中药敷脐联合中药保留灌肠治疗肝硬化腹水的有效性及安全性。[方法]在PubMed、EBSCO、中国知网、维普、万方、中国生物医学文献服务系统(SinoMed)中全面检索运用中药敷脐联合中药保留灌肠治疗肝硬化腹水的随机对照临床研究文献,检索时间从2003年1月1日~2019年12月31日。依据Jadad改良法评分量表进行文献质量及文献偏倚风险评价,Meta分析采用Review Manger(RevMan)5.3软件,并对结果进行亚组分析及敏感性分析。[结果]对10篇符合纳入标准的文献进行分析,总计肝硬化腹水患者883例。有关临床疗效Meta分析结果显示,与单纯西医治疗相比,运用中药敷脐联合中药保留灌肠治疗肝硬化腹水可显著提高临床有效率(Z=7.98,P<0.000 01,OR=4.21,95%CI 2.96~5.99)。不良反应主要为局部皮肤红肿瘙痒。[结论]中药敷脐联合中药保留灌肠较单纯西医治疗在治疗肝硬化腹水症状的有效率,以及体重、腹围、24 h尿量的改善程度方面表现更优,而在改善患者肝功能、利尿方面效果不明确。该研究纳入文献质量及数量有限,中药敷脐联合中药保留灌肠的临床疗效亟待更多高质量研究进行验证。Abstract: [Objective]To evaluate the efficacy and safety of integrated umbilical compress therapy and enema treatment for liver cirrhosis.[Methods]A systematic search of clinical research regarding umbilical compress therapy and enema treatment for liver cirrhosis was conducted.This study retrieved PubMed,EBSCO,CNKI,VIP,Wan-Fang and SinoMed Data for randomized controlled trials from January 1 st 2003 to December 31 st 2019.Included studies were assessed the risk of bias according to Jadad Quality Scale.And Meta-analysis was performed by RevMan 5.3 software.[Results]Ten RCTs involving 883 liver cirrhosis patients were included.The results of this study indicated that the effective rate of integrated umbilical compress therapy and enema treatment(OR=4.21,95%CI 2.96-5.99,P<0.000 01)were higher than that in the conventional western medicine treatment.The major side effect is skin itching and swelling.[Conclusion]Integrated umbilical compress therapy and enema treatment is superior to conventional western medicine treatment alone in the effective rate,weight,and abdominal perimeter,while the effect of improving the liver function indicators and 24 hr urine remained unclear.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify above conclusion.
-
Key words:
- umbilical compress therapy /
- enema treatment /
- liver cirrhosis /
- Meta-analysis
-
-
[1] 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志,2017,30(10):1847-1863.
[2] 刘成海,幸鹭,朱亭亭.乙肝肝硬化的中西医结合治疗策略[J].中国中西医结合消化杂志,2018,26(12):973-977.
[3] 陈珊,祝峻峰.中药敷脐治疗肝硬化腹水的国内研究进展[J].成都中医药大学学报,2016,39(4):110-114.
[4] 曾贞,邢枫,赵钢,等.中药敷脐治疗肝硬化腹水研究进展[J].中医外治杂志,2009,18(5):45-47.
[5] 许辰,高泽立,张建表,等.非酒精性脂肪肝进展至肝硬化的危险因素分析及预测模型构建[J].中国中西医结合消化杂志,2019,27(10):772-776.
[6] Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement[J].PLoS Med,2009,6(7):e1000097.
[7] Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary[J]?Controlled Clin Trials,1996,17(1):1-12.
[8] Arroyo V,Gines P,Gerbes AL,et al.Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis[J].Hepatology,1996,23(1):164-176.
[9] 王吉耀.现代肝病治疗学[M].上海:上海医科大学出版社,1999.
[10] 中国中西医结合学会消化系统疾病专业委员会.肝硬化中西医结合诊治方案[J].现代消化及介入诊疗,2005,10(2):119-121.
[11] 陈灏珠.实用内科学[M].北京:人民卫生出版社,2013:2003-2004.
[12] European Association For The Study Of The Liver.EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J].J Hepatol,2010,53(3):397-417.
[13] 中华医学会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[14] 戴瑞鸿.内科疾病诊断标准[M].上海:上海科技教育出版社,1991:122-122.
[15] 叶任高,陆再英.内科学[M].北京:人民卫生出版社,2004.
[16] 中国中医药学会内科肝病专业委员会.肝硬变腹水中医疗效判定标准(试行)草案[C]//中国中医药学会内科肝病专业委员会大连会议.1993.
[17] 陈佑邦.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:10-11.
[18] 张育轩.肝硬化临床诊断,中西辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994,14(4):237-238.
[19] 李晏杰,毛德文,黄雪霞,等.加用甘遂末敷脐联合中药灌肠治疗肝硬化腹水的临床研究[J].广西中医药,2015,38(2):9-11.
[20] 杨秀珍,韩立彬,沈美龙,等.中西医结合治疗肝硬化难治性腹水疗效观察[J].肝脏,2013 18(8):584-585.
[21] 毛毛,孙永浩.甘陆散敷脐联合大黄解毒汤保留灌肠治疗肝硬化腹水临床观察[J].辽宁中医杂志,2014,41(6):1173-1175.
[22] 陈琳.外敷、灌肠、辨证分型联合西药治疗乙肝后肝硬化腹水随机平行对照研究[J].实用中医内科杂志,2014,28(8):86-88.
[23] 杨阳,梁宝慧,林鹃.蜀椒麝香散脐敷结合中药灌肠对肝硬化患者的外周血流动力学及对ET,ED,NO的影响[J].光明中医,2015,30(2):277-279.
[24] 童光东,周大桥,贺劲松,等.麝黄膏敷脐配合中药结肠透析治疗难治性肝硬化腹水合并氮质血症的临床研究[J].中国中西医结合杂志,2008,28(9):788-792.
[25] 刘光伟,费景兰,王春芳,等.退黄合剂保留灌肠联合逐水方敷脐治疗肝硬化顽固性腹水临床疗效观察[J].时珍国医国药,2015,26(3):662-663.
[26] 徐双林.中医综合疗法治疗乙肝后肝硬化腹水的临床观察[J].湖北中医杂志,2013,35(2):14-15.
[27] 王宇亮,党中勤,赵长普,等.中药外敷加保留灌肠治疗肝硬化腹水40例[J].中国民间疗法,2011,19(1):23-24.
[28] 董桂芬.中药灌肠及外敷治疗肝硬化腹水疗效观察[J].山西中医,2015,31(4):41-41.
-
计量
- 文章访问数: 464
- PDF下载数: 486
- 施引文献: 0
下载: