基于“脾胃气机升降”理论探讨5种中医经典方剂治疗糖尿病胃轻瘫的网状Meta分析  

A Network Meta-Analysis of Five Classical Traditional Chinese Medicine Prescriptions in the Treatment of Diabetic Gastroparesis Based on Piweiqijishengjiang Theory

作　　者：苏嘉楠 李京[2] 敖玉涵 孙贵炎 安继仁 张栏译 张仕衡 孙婉萍[6] 石岩[1] 刘宁[2] SU Jianan;LI Jing;AO Yuhan;SUN Guiyan;AN Jiren;ZHANG Lanyi;ZHANG Shiheng;SUN Wanping;SHI Yan;LIU Ning(College of Traditional Chinese Medicine,Liaoning University of Traditional Chinese Medicine,Shenyang 110847;Affliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110847;First Clinical College of Liaoning University of Traditional Chinese Medicine,Shenyang 110847;College of Integrated Chinese and Western Medicine,Hebei University of Traditional Chinese Medicine,Shijiazhuang 050200;College of Integrated Chinese and Western Medicine,Liaoning University of Traditional Chinese Medicine,Shenyangg 110847;Cllege of Medicine,Liaoning University of Traditional Chinese Medicine,Dalian 116600)

机构地区：[1]辽宁中医药大学中医学院,沈阳110847 [2]辽宁中医药大学附属医院,沈阳110847 [3]辽宁中医药大学第一临床学院,沈阳110847 [4]河北中医药大学中西医结合学院,石家庄050200 [5]辽宁中医药大学中西结合学院,沈阳110847 [6]辽宁中医药大学药学院,大连116600

出　　处：《中药药理与临床》2025年第2期71-79,共9页Pharmacology and Clinics of Chinese Materia Medica

基　　金：岐黄学者-国家中医药领军人才支持计划项目(编号:[2018]12);辽宁省科技计划联合计划应用基础研究项目(编号:2023JH2/101700229);辽宁省科技计划联合计划(自然科学-博士启动项目)(编号:2024-BSLH-153);辽宁省科技计划联合计划(自然科学-博士启动项目)(编号:2024-BSLH-152);辽宁省科技计划联合计划(自然科学-博士启动项目)(编号:2024-BSLH-149);辽宁省科技计划联合计划(自然科学-博士启动项目)(编号:2024-BSLH-150);辽宁省应用基础研究计划项目(编号:2023JH2/101600028)。

摘　　要：目的:对半夏泻心汤、四磨汤、乌梅丸、香砂六君子汤、枳实消痞汤等5种以调理“脾胃气机升降”为主要治则的方剂进行分析,系统评价其在DGP治疗中的有效性及安全性。方法:按照循证医学要求,全面检索Web of science、PubMed、Embase、Cochrane Library、知网、万方、维普、中国生物医学等国内外数据库2012年1月-2022年12月收录的半夏泻心汤、四磨汤、乌梅丸、香砂六君子汤、枳实消痞汤治疗DGP的RCT文献。采用Revman5.4进行文献质量评价,采用Stata16.0完成数据分析,同时绘制网络关系图、比较-校正漏斗图、累积SUCRA图及聚类分析图。结果:共纳入61篇RCT文献,5309例患者(治疗组2667例,对照组2642例)。网状Meta分析结果显示5种方剂能够显著提高DGP的治疗有效率,降低DGP患者空腹血糖水平,提高患者胃排空率,改善胃动素和生长抑素的分泌情况。排序结果显示,枳实消痞汤是提高DGP有效率的最佳选择,乌梅丸是降低FPG、提高胃排空率的最佳选择,枳实消痞汤+西医常规治疗是改善胃动素分泌的最佳选择,半夏泻心汤+西医常规治疗是改善生长抑素分泌的最佳选择。结论:5种方剂能有效提高DGP临床有效率,降低血糖、提高胃排空能力并改善胃肠激素分泌情况。然而,受纳入研究的限制,其结论仍需开展更多大样本、多中心、高质量的RCT予以验证。Objective:To analyze five traditional Chinese medicine(TCM)prescriptions following Piweiqijishengjiang treatment theory,such as Banxia Xiexin Decoction(半夏泻心汤),Simo Decoction(四磨汤),Wumei Pill(乌梅丸),Xiangsha Liujunzi Decoction(香砂六君子汤),and Zhishi Xiaopi Decoction(枳实消痞汤)and systematically evaluate their effectiveness and safety in the treatment of diabetic gastro-paresis(DGP).Methods:According to the requirements of evidence-based medicine,literature related to randomized controlled trials(RCTs)on the treatment of DGP by using Banxia Xiexin Decoction,Simo Decoction,Wumei Pill,Xiangsha Liujunzi Decoction,and Zhishi Xi-aopi Decoction was searched in Chinese and foreign databases such as Web of Science,PubMed,Embase,Cochrane Library,CNKI,Wanfang,VIP,and Chinese Biomedical Science from January 2012 to December 2022.Revman5.4 was used for literature quality evaluation,and Sta-ta16.0 was used for data analysis.Network relationship diagrams,comparison-correction funnel diagrams,cumulative SUCRA diagrams,and cluster analysis diagrams were drawn.Results:A total of 61 pieces of literature related to RCTs were included,involving 5309 patients(2667 in the treatment group and 2642 in the control group).The results of the network meta-analysis showed that five TCM prescriptions could significantly enhance the therapeutic efficiency of DGP,reduce the fasting blood glucose(FPG)level of DGP patients,increase the gas-tric emptying rate,and improve the secretion of motilin and somatostatin.The sorting results showed that Zhishi Xiaopi Decoction was the best choice to improve the effective rate of DGP,and Wumei Pill was the best choice to reduce FPG and increase the gastric emptying rate.Zhishi Xiaopi Decoction+WM was the best choice to improve motilin secretion,while Banxia Xiexin Decoction+WM was the best choice to improve somatostatin secretion.Conclusion:Five TCM prescriptions can effectively improve the clinical efficacy of DGP,reduce blood sugar,enhance gastric emptying ability,and promote

关 键 词：半夏泻心汤 四磨汤 乌梅丸 香砂六君子汤 枳实消痞汤 中医疗法 脾胃气机升降 糖尿病胃轻瘫 网状Meta分析 

分 类 号：R259[医药卫生—中西医结合]