【作者】 张昔伟； 王林恒； 张伟戈； 高霞； 王婷玉； 孟捷；

【机构】 北京中医药大学东方医院；

【摘要】 目的:运用Meta分析的方法对利胆清胰汤口服联合ERCP治疗胆源性胰腺炎的临床疗效进行评价。方法:计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、Cochrane以及CSCI数据库,检索时限为建库至2019年2月,2名评价者独立筛选文献、提取资料和评价纳入研究偏倚后,采用RevMan5.3软件进行Meta分析。结果:最终纳入7项随机对照试验(RCT),总病例数449例。分析结果显示,与对照组比较,利胆清胰汤联合ERCP治疗急性胆源性胰腺炎(ABP)临床有效率更高[OR=4.04,95%CI(2.11,7.75),P<0.0001],并能降低中医证候学总积分,[OR=-4.12,95%CI(-4.86,-3.65),P<0.00001]、APACHE-Ⅱ评分[OR=-3.72,95%CI(-4.16,-3.29),P<0.00001]、尿淀粉酶水平[OR=-191.17,95%CI(-296.49,-85.85),P<0.00001]、血淀粉酶水平[OR=-46.83,95%CI(-80.71,-12.95),P<0.00001]、血清IL-6水平[OR=-12.43,95%CI(-26.76,1.89),P=0.006]、血清IL-15水平[OR=-17.31,95%CI(-32.42,-2.21),P=0.0003]、血清IL-18水平[OR=-44.70,95%CI(-85.56,-3.84),P<0.0001]、白细胞计数[OR=-2.59,95%CI(-3.07,-2.11),P<0.00001]。结论:在ERCP基础上联合利胆清胰汤口服治疗ABP,可提高临床疗效,降低中医证候学总积分,APACHE-Ⅱ评分,血、尿淀粉酶水平,降低血清炎症因子IL-6、IL-15、IL-18水平及白细胞计数。但纳入文献质量偏低,需高质量大样本量RCT进一步验证。更多还原

【Abstract】 Objective To conduct the meta-analysis on Clinical efficacy of Lidanqingyi Decoction combined with ERCP in the treatment of biliary pancreatitis.Methods The CNKI,WanFangData,VIP,CBM PubMed,Cochrane and CSCI databases were retrieved from the time of database establishment to February 2019.2 reviewers screened the literatures,extracted data and evaluated the bias of the included trials independently.Afterwards,usingRevMan5.3 software,themeta-analysiswas conducted-ReaultsFinally,7 RCTswereincluded,with449 cases.Theanalysisresults showedthatcomparedwiththecontrolgroup,theclinicalefficiencyoflidanqingyi decoction combined with ERCP in the treatment of acute biliary pancreatitis(ABP) is higher [OR=4.04,95% CI(2.11,7.75),P<0.0001].The treatment reduced total score of TCM syndromes [OR=-4.12,95% CI(-4.86,-3.65),P<0.00001],and reduced APACHE-II [OR=-3.72,95% CI(-4.16,-3.29),P<0.00001].The treatment reduced amylase in Urine [OR=-191.17,95% CI(-296.49,-85.85),P<0.00001,] in blood [OR=-46.83,95% CI(-80.71,-12.95),P<0.00001],reduced Serum IL-6 level [OR=-12.43,95%CI(-26.76,1.89),P=0.006,] reduced Serum IL-15 level[OR=-17.31,95% CI(-32.42,-2.21),P=0.0003,] reduced Serum IL-18 level [OR=-44.70,95% CI(-85.56,-3.84),P<0.0001,] reduced whitebloodcell [OR=-2.59,95%CI(-3.07,-2.11),P<0.00001].Conclusions:OnthebasisofERCP,combinedwithLidanqingyi tang for oral treatment of ABP can improve clinical efficacy,reduce TCM syndrome total score,APACHE-II score,blood and urine amylase level,and decrease serum inflammatory factors IL-6,IL-15 IL-18 levels and white blood cell counts.However,the quality of the included literature is low,and more high quality studies are needed to verify above mentioned conclusion.更多还原