凉血解毒法治疗乙肝慢加急性肝衰竭疗效的Meta分析  

Meta-analysis of the Effect of Liangxue Jiedu Therapy on Hepatitis B and Acute-on-Chronic Liver Failure

作　　者：朱冰冰 陈宇 高方媛[3] 王宪波[3] 杨晋翔 ZHU Bingbing;CHEN Yu;GAO Fangyuan;WANG Xianbo;YANG Jinxiang(Beijing University of Chinese Medicine,Beijing 100029,China;Department of Spleen and Stomach,Third Affiliated Hospital,Beijing University of Chinese Medicine,Beijing100029,China;Center for Combined TCM and Western Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第三附属医院脾胃科,北京100029 [3]首都医科大学附属北京地坛医院中西医结合中心,北京100015

出　　处：《世界中医药》2022年第8期1086-1094,共9页World Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(81804009)。

摘　　要：目的:评价凉血解毒法治疗乙肝慢加急性肝衰竭(HBV Acute-on-chronic Liver Failure,HBV-ACLF)的治疗效果和安全性。方法:计算机检索2010年1月至2020年5月公开发表的以中医凉血解毒法为干预手段治疗HBV-ACLF的临床随机对照试验。依照纳排标准进行文献筛选、质量风险评估和资料提取,通过RevMan5.3软件进行荟萃分析。结果:最终纳入20项随机对照试验,共1812例患者。Meta分析结果显示凉血解毒法可以改善临床总有效率(OR=2.61,95%CI为1.93~3.52,Z=6.24,P<0.00001);降低临床死亡率(OR=0.39,95%CI为0.29~0.53,Z=6.14,P<0.00001),降低GPT(MD=-20.86,95%CI为-29.91~-11.80,Z=4.51,P<0.00001)、GOT(MD-4.99,95%CI为-8.05~-1.92,Z=3.19,P=0.001)、TBil(MD=-40.47,95%CI为-45.69~-35.25,Z=15.19,P<0.00001)、MELD(MD=1.19,95%CI为0.29~2.09,Z=2.90,P=0.01),提高白蛋白(MD=2.57,95%CI为1.95~3.19,Z=8.13,P<0.00001)、胆碱酯酶(MD=1.15,95%CI为0.37~1.92,Z=2.90,P=0.004)、凝血酶原活性(MD=11.2、46,95%CI为9.32~13.60,Z=10.50,P<0.00001)水平,改善中医证候(MD=-3.65,95%CI为-4.63~-2.67,Z=7.92,P<0.00001),差异有统计学意义。其中4项临床研究报告了应用凉血解毒法治疗HBV-ACLF的不良反应,并显示其不良反应可自行缓解。结论:凉血解毒法可提高HBV-ACLF患者的临床有效率,降低临床死亡率、改善肝功、凝血功能,且不良反应发生率较低。Objective:This study evaluated the efficacy and safety of Liangxue Jiedu therapy in the treatment of hepatitis B and acute-on-chronic liver failure(HBV-ACLF).Methods:We searched the major databases for randomized controlled trials on the treatment of HBV-ACLF with Liangxue Jiedu therapy(January 2010-May 2020),followed by screening accoring to the exclusion criteria,quality assessment,and data collection.RevMan5.3 was employed for Meta-analysis.Results:A total of 20 randomized controlled trials involving 1812 cases were included.Meta-analysis results showed that Liangxue Jiedu therapy can significantly raise the total clinical effective rate(OR=2.61,95%CI 1.93 to 3.52,Z=6.24,P<0.00001),reduce clinical mortality(OR=0.39,95%CI 0.29 to 0.53,Z=6.14,P<0.00001),GPT(MD=-20.86,95%CI-29.91 to-11.80,Z=4.51,P<0.00001),GOT(MD=-4.99,95%CI-8.05 to-1.92,Z=3.19,P=0.001),TBil(MD=-40.47,95%CI-45.69 to-35.25,Z=15.19,P<0.00001),and MELD(MD=1.19,95%CI 0.29 to 2.09,Z=2.90,P=0.01),and improve levels of ALB(MD=2.57,95%CI 1.95 to 3.19,Z=8.13,P<0.00001),CHE(MD=1.15,95%CI 0.37 to 1.92,Z=2.90,P=0.004),and PTA(MD=11.2,46,95%CI 9.32 to 13.60,Z=10.50,P<0.00001),and traditional Chinese medicine(TCM)syndrome(MD=-3.65,95%CI-4.63 to-2.67,Z=7.92,P<0.00001).Four studies reported the relevant adverse reactions of the Liangxue Jiedu therapy,all of which,however,disappeared spontaneously.Conclusion:Liangxue Jiedu therapy can raise the clinical effective rates in patients with HBV-ACLF,thus reducing the mortality,and improve liver function and blood coagulation,with seldom occurrence of adverse reactions.

关 键 词：慢加急性肝衰竭 乙型病毒性肝炎 凉血解毒法 随机对照试验 治疗 安全性 系统评价 META分析 

分 类 号：R256.5[医药卫生—中医内科学]