中药复方干预抗结核化疗致肝损伤疗效的系统评价
Systematic Evaluation on the Effect of Chinese Medicine Formula on the Intervention of Liver Injury Induced by Anti-Tuberculosis Chemotherapy
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摘要: 目的 系统评价中药复方干预抗结核化疗致肝损伤的有效性。方法 计算机检索中国知网、维普期刊数据库、万方数据和Pub Med数据库，搜集中药复方干预抗结核化疗致肝损伤的随机对照试验（RCT），检索时限均为建库至2019年3月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果 共纳入17个RCT，共计1 410位抗结核化疗致肝损伤患者。Meta分析结果提示:与常规保肝治疗比较，中药复方干预抗结核化疗致肝损伤的有效率［RR=1.83，95%CI（1.50，2.23），P<0.01］、血清谷丙转氨酶（ALT）［MD=-50.38，95%CI（-54.17，-46.58），P<0.01］、谷草转氨酶（AST）［MD=-61.65，95%CI（-72.68，-50.61），P<0.01］、总胆红素（TBiL）［MD=-11.02，95%CI（-13.24，-8.79），P<0.01］均优于对照组。结论 中药复方更有利于减轻和控制抗结核化疗过程中肝损伤的发生，对保证结核病人规律服药，控制病情、完成抗结核治疗方案具有重要的意义。Abstract: OBJECTIVE To systematically evaluate the efficacy of Chinese medicine formula in the intervention of liver injury induced by anti-tuberculosis chemotherapy. METHODS CNKI， VIP， Wanfang Data and Pub Med databases were searched to collect randomized controlled trial (RCT) of Chinese medicine formula in intervention of liver injury induced by anti-tuberculosis chemotherapy from inception to the first of March 1， 2019. Two reviewers independently screened literature， extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. RESULTS A total of 17 RCTs involving 1 410 patients with liver injury caused by anti-tuberculosis chemotherapy were included. The results showed that compared to the conventional treatment to protecting liver， intervention with Chinese medicine formula could significantly improve the effective rate [RR=1.83，95%CI(1.50，2.23)，P<0.01]， and its serum glutamic pyruvic transaminase (ALT) [MD=-50.38，95%CI(-54.17，-46.58)，P<0.01]， glutamic oxalacetic transaminase (AST)[MD=-61.65，95%CI(-72.68，-50.61)，P<0.01]， and total bilirubin (TBiL) [MD=-11.02，95%CI(-13.24，-8.79)，P<0.01] were all better. CONCLUSION Current evidence shows that Chinese medicine formula is more conducive to reduce and control the occurrence of liver injury in the course of anti-tuberculosis treatment. It is of great significance to ensure that tuberculosis patients take drugs regularly， control their condition and complete the anti-tuberculosis treatment program.
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[1] World Health Organization. Global Tuberculosis Report 2018[EB/OL]. (2017-11-17)[2018-03-15]. https://www.who.int/tb/publications/global_report/en. [2] ZHOU Y，YANG L，LIAO Z，et al. Epidemiology of drug-in-duced liver injury in China: A systematic analysis of the Chinese literature including 21 789 patients[J].Eur J Gastroenterol Hepatol，2013，25(7): 825-829. [3] 国家中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社，1994． [4] 王爱华，张志.柴胡栀子汤治疗抗痨药物所致肝损害52例[J].光明中医，2012，27(10):2033-2034. [5] 董爱峰，李华荣，徐桂英.解毒护肝汤治疗抗结核药物性肝损害42例[J].河南中医，2008，28(10):58-59. [6] XIAN YS，WANG ZR，GONG XF， et al.Clinical study on ganbi decoction in treating antituberculotic agent-caused liver injury[J]. Chin J Integr Med，2006，12(2): 107-111. [7] 沈欣，李凫坚.疏肝汤治疗抗结核药肝损害临床观察[J].浙江中西医结合杂志，2008，18(4): 227-228. [8] 刘明山.四逆疏肝汤对耐药肺结核患者抗结核药物治疗中所致肝功能损害的疗效评价[J].抗感染药学，2017，14(7): 1399-1401. [9] 孙长明，杜天虹.茵陈蒿汤加味治疗抗结核药致肝损害观察[J].医药论坛杂志，2007，28(10):73. [10] 高淑俊.四逆疏肝汤治疗耐药性肺结核病所致肝损伤临床观察[J].光明中医，2018，33(24): 3694-3696. [11] 朱旭霞.中西医结合治疗抗结核药所致肝损害疗效观察[J].浙江中医药大学学报，2009，33(3):343-344. [12] 王学教.逍遥散加味治疗抗痨药物性肝损害疗效观察[J].湖北中医杂志，2009，31(7):29-30. [13] 谢登煌，胡振辉，何华英.健脾养肝散治疗抗痨化疗肝损害48例[J].实用中医内科杂志，2005，19(4):369-370. [14] 李琴.中药治疗抗痨药物所致肝损害34例[J].中西医结合肝病杂志，1999，9(3):15. [15] 刘鲁明，杜卫红.中西医结合治疗抗痨药性肝损伤30例疗效观察[J].国医论坛，2008，23(5):33-34. [16] 谷灿立，付月箫.复肝汤治疗25例抗痨药物引起的肝脏损害疗效观察[J].基层医学论坛，2003，7(10):917-918. [17] 杨敏.中西医结合治疗抗结核药所致肝损害32例[J].实用中西医结合临床，2005，5(2):14-15. [18] 夏俊娣.清肝降酶汤治疗抗结核药物肝损害[A]//中华医学会结核病学分会.全国抗结核治疗的不良反应及处理学术会议论文汇编.成都:中华医学会结核病学分会，2001:6-8. [19] 路振宇，党殿杰，王京，等.百丹疏肝方治疗抗肺结核合并真菌感染药物所致肝损伤196例疗效观察[J].山东中医杂志，2017，36(8):647-649，653. [20] 李敏，李丽.中西医结合治疗抗结核药物性肝损伤55例疗效观察[J].世界中西医结合杂志，2009，4(11):810-811. -
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