柴胡疏肝散加减治疗甲状腺功能亢进症的Meta分析和试验序贯分析  

Modified Chaihu Shugan Powder in the Treatment of Hyperthyroidism:A Meta-analysis and Trial Sequential Analysis

作　　者：黄盛 商建伟[1] 陈晓珩[1] 祁烁[1,2] 李哲[1] 李会龙[1] 高妙然 丁治国[2] HUANG Sheng;SHANG Jian-wei;CHEN Xiao-heng;QI Shuo;LI Zhe;LI Hui-long;GAO Miao-ran;DINGZhi-guo(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700;Sunsimiao Hospital,Beijing University of Chinese Medicine,Tongchuan Shaanxi 727100;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学孙思邈医院,陕西铜川727100 [3]北京中医药大学东方医院,北京100078

出　　处：《世界中西医结合杂志》2023年第2期236-243,共8页World Journal of Integrated Traditional and Western Medicine

基　　金：北京市薪火传承“3+3”工程项目(2016-SZ-C-61);陕西省中医药管理局科研项目(2021-GJ-LC001)。

摘　　要：目的系统评价柴胡疏肝散加减治疗甲状腺功能亢进症的有效性和安全性,为临床治疗方案提供循证参考。方法计算机检索CNKI、万方、PubMed、Embase、CochraneLibrary等数据库,检索日期从建库至2021年12月。检索关于柴胡疏肝散加减治疗甲状腺功能亢进症的随机对照试验(Randomized controlled trial,RCT),从中提取符合相关要求的数据。使用Cochrane 5.1.0风险偏倚评估工具对纳入研究进行质量评价,后运用Stata 16.0软件进行Meta分析,使用R软件绘制附加轮廓线漏斗图辅助判断漏斗图不对称的原因,最后用TSA0.9软件进行试验序贯分析。结果共纳入21项RCT研究,涉及1765例患者。Meta分析结果提示试验组(柴胡疏肝散加减联合西药)患者总有效率[RR=1.31,95%CI(1.25,1.38),P<0.05]、血清甲状腺激素水平[WMD_(FT3)=-3.47,95%CI(-4.37,-2.58),P<0.05;WMD_(FT4)=-7.17,95%CI(-8.87,-5.47),P<0.05;WMD_(TSH)=0.19,95%CI(0.06,0.33),P<0.05]和不良反应发生率[RR=0.29,95%CI(0.20,0.43),P<0.05]明显优于对照组(常规西药治疗),差异均有统计学意义。结论柴胡疏肝散加减联合西药治疗甲状腺功能亢进症,相较于单用西药治疗更具优势,但受纳入研究质量的影响,研究结果可能有一定局限性,未来仍需更多高质量RCT研究进一步验证其疗效和安全性。Objective To systematically evaluate the efficacy and safety of modified Chaihu Shugan Powder in the treatment of hyperthyroidism,and provide evidence-based references for clinical treatment protocols.Methods Randomized controlled trials(RCTs)on the treatment of hyperthyroidism with modified Chaihu Shugan Powder in China National Knowledge Infrastructure(CNKI),Wanfang,PubMed,Embase,Cochrane Library,and other databases from the establishment of the database to December 2021 were retrieved.Data that met the relevant requirements were extracted.The quality of the included studies was evaluated using the Cochrane 5.1.0 tool for assessing risk of bias,and Meta-analysis was performed using Stata 16.0.The contour-enhanced funnel plot was drawn using R to assist in determining the cause of funnel plot asymmetry,and trial sequential analysis was conducted using TSA 0.9.Results Twenty-one RCTs involving 1765 patients were included.Meta-analysis suggested that in the experimental group(modified Chaihu Shugan Powder combined with western medicine),the total effective rate[RR=1.31,95%CI(1.25,1.38),P<0.05],serum thyroid hormone level[WMD_(FT3)=-3.47,95%CI(-4.37,-2.58),P<0.05;WMD_(FT4)=-7.17,95%CI(-8.87,-5.47),P<0.05;WMD_(TSH)=0.19,95%CI(0.06,0.33),P<0.05],and the incidence of adverse effects[RR=0.29,95%CI(0.20,0.43),P<0.05]were significantly superior to those in the control group(conventional western medicine).Conclusion The effect of modified Chaihu Shugan Powder combined with western medicine on the treatment of hyperthyroidism is betterthan that of western medicine alone.However,the study results may have some limitations due to the quality of the included studies,and more high-quality RCTs are still needed for further validation.

关 键 词：柴胡疏肝散 甲状腺功能亢进症 系统评价 META分析 序贯分析 

分 类 号：R581.1[医药卫生—内分泌]