Efficacy of herbal medicine (Gegen Qinlian Decoction) on ulcerative colitis A systematic review of randomized controlled trials
Efficacy of herbal medicine (Gegen Qinlian Decoction) on ulcerative colitis A systematic review of randomized controlled trials
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DOI：
10.1097/md.0000000000018512
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发表时间：
2019-12-01
期刊：
影响因子：
1.6
通讯作者：
Feng, Zhitao
中科院分区：
文献类型：
--
作者：
Fan, Yuling;Yi, Wen;Feng, Zhitao
背景：本系统综述旨在评价葛根芩连汤（GQD）治疗溃疡性结肠炎（UC）的疗效。方法：检索PubMed、EMBASE、Springer LINK、Cochrane Library、中国国家知识基础设施、重庆维普中文技术期刊数据库、万方数据库和中国生物医学数据库，检索自建库至12月 2018 年随机对照试验比较了单独使用 GQD 或与西药 (WM) 联合使用与 WM 疗法治疗 UC 的效果。通过Review Manager 5.3软件提取并分析治疗有效率、溃疡性结肠炎内镜严重指数（UCEIS）、复发率和不良事件的结果。荟萃分析与固定或随机效应模型相结合，并计算所有结果的风险比 (RR) 和 95% 置信区间 (CI)。两名研究人员独立审查每项试验以确定其纳入范围。使用 Cochrane 偏倚风险评估工具进行质量评估。结果：我们纳入了 22 项试验，涉及 2028 名 UC 患者。与 WM 治疗相比，GQD 显着提高了临床疗效 (n =591，RR =1.21，95% CI：1.12-1.31，P < .00001) 和复发率 (n =94，RR =0.23，95% CI：0.10-0.54，P= 0.0006)。 GOD 联合 WM 在提高临床疗效（n=1337，RR = 1.21，95% CI：1.16-1.27，P< .00001）、降低 UCEIS 评分（n = 384，平均差 = -0.63，95% CI：-1.26--0.01，P= .05）、复发率（n = 179，相对比=0.18， 95% CI：0.06-0.61，P=.006）。此外，GOD（n=238，RR=0.20，95% CI：0.02-1.68，P=.14）和GQD加WM（n=427，RR=.0.37，95% CI：0.15-0.90，P=.03）的不良事件显着低于单独使用WM。注意到的不良事件主要包括胃肠道症状、头痛、头晕和白细胞减少。结论：这项荟萃分析表明，GQD 单独使用或与 WM 联合使用可能对治疗 UC 具有潜在益处。然而。由于纳入试验的方法学质量较差，没有足够的证据得出支持 GQD 对 UC 疗效的明确结论。应进行更严格设计的大样本调查和研究，以进一步建立临床证据。
Background: This systematic review aims to evaluate the efficacy of Gegen Qinlian Decoction (GQD) for ulcerative colitis (UC).Methods: PubMed, EMBASE, Springer LINK, Cochrane Library, the China National Knowledge Infrastructure, Chongqing Weipu Database for Chinese Technical Periodicals, Wan-fang Database, and Chinese Biomedicine Database were searched from their inception to December 2018 for randomized controlled trials comparing the use of GQD alone or in combination with western medicine (WM) with that of WM therapies for UC. Outcomes on the therapy's effectiveness rate, ulcerative colitis endoscopic index of severity (UCEIS), recurrence rate, and adverse events were extracted and analyzed by Review Manager 5.3 software. Meta-analysis was combined with fixed or random-effects model, and risk ratios (RR) and 95% confidence intervals (CI) were calculated for all outcomes. Two researchers independently reviewed each trial to determine its inclusion. The Cochrane risk of bias assessment tool was used for quality assessment.Results: We included 22 trials involving 2028 patients with UC. When compared with WM therapy, GQD significantly improved the clinical effectiveness (n =591, RR =1.21, 95% CI: 1.12-1.31, P < .00001) and recurrence rate (n =94, RR =0.23, 95% CI: 0.10-0.54, P= .0006). GOD plus WM was more effective in improving the clinical effectiveness (n=1337, RR = 1.21, 95% CI: 1.16-1.27, P< .00001), and decreasing UCEIS scores (n =384, mean difference = -0.63, 95% CI: -1.26--0.01, P= .05), recurrence rate (n = 179, RR =0.18, 95% CI: 0.06-0.61, P=.006). In addition, the adverse events for GOD (n=238, RR =0.20, 95% CI: 0.02-1.68, P=.14) and GQD plus WM (n=427, RR=.0.37, 95% CI: 0.15-0.90, P=.03) was significantly lower than that for WM alone. Noted adverse events primarily included gastrointestinal symptoms, headache, dizziness, and leukocytopenia.Conclusions: This meta-analysis shows that GQD used alone or in combination with WM might have potential benefits in curing UC. However. there is no sufficient evidence to draw definite conclusion supporting the effect of GQD for UC due to poor methodological quality of the included trials. More rigorously designed investigations and studies with large sample sizes should be conducted to establish clinical evidence further.