以痛泻要方为基本方治疗肠易激综合征随机对照试验系统评价.doc

以痛泻要方为基本方治疗肠易激综合征随机对照试验系统评价 作者：苏国彬，刘文华，陈海滨，郭新峰 【摘要】 【目的】评价以痛泻要方为基本方治疗肝 郁脾虚型肠易激综合征(IBS)的疗效。【方法】以“痛泻要 方”、“肠易激综合征”、“随机对照试验”为关键词，在 国内外中英文主要学术论文数据库查找，并进行相关参考文 献的检索，用经过验证的中医药治疗性文献信息采集表对纳 入的研究进行数据的采集与质量评价。以主要症状(腹痛、 大便形状、大便频率等)和/或总体疗效评价以及生存质量 为结局指标，将纳入文献分为腹泻型和不分亚型、中医辨证 组和未配合中医辨证组等亚组，用Review Manager 4 2进 行数据管理与Meta分析。用漏斗图分析发表性偏倚。【结果】 46个随机对照试验符合纳入标准，共包括4 155例患者。以 痛泻要方为基本方治疗IBS的疗效优于西药或安慰剂，其差 异有统计学意义［OR为5 30, 95%CI (4 38, 6 41)］。 亚组分析中，治疗腹泻型IBS的OR值［0R为5 61, 95%CI (4 33, 7 25)］高于不分亚型组OR值［OR为4 95, 95%CI (3 74, 6 55)］,但差异无统计学意义；痛泻要方为基本 方配合中医辨证加减治疗腹泻型IBS的OR值［OR为6 50, 95%CI (3 78, 11 20)］高于未配合中医辨证组OR值［OR 为5 37, 95%CI (4 01, 7 19)］,但差异无统计学意义。 存在发表性偏倚。【结论】以痛泻要方为基本方治疗中医辨 证为肝郁脾虚型的腹泻型肠易激综合征的效果优于西药或 安慰剂，但尚未能证实配合中医辨证加减的疗效优于基本 方，腹泻型疗效优于便秘型等其他类型；研究的总体质量偏 低，受偏倚影响的机会较大；个别高质量研究的阴性结果值 得进一步探讨。 【关键词】肠易激综合征/中药疗法；痛泻要方/治疗应 用；系统评价 Abstract：ObjectiveTo assess the effectiveness of the Chinese herbal formula Tongxie Yaofang(TY) or its modified prescriptions in the management of irritable bowl syndrome (IBS)?MethodsA systematic review was carried out according to the Cochrane standards? A computerized literature search was carried out in main Chinese and English databases including CNKI,CBMdi sc,Database of Chinese Doctorate Dissertation,Database of excellent Chinese Master Dissertation,MEDLINE and Cochrane Library. Studies were retrieved when they were randomized controlled trials (RCTs) whose interventions for IBS patients were TY or modified prescriptions of TY with placebos or conventional medicine as controls? Outcome measurement included the alleviation of main symptoms such as abdominal pain,diarrhea frequency,and (or) comprehensive effectiveness and quality of life (QOL).Meta analysis was performed after evaluating the quality of included studies .Subgroup analysis was done between subgroups of diarrhea predominant IBS and subtype regardless IBS,and was also done between diarrhea predominant IBS treated with TCM syndrome differentiation and that without TCM syndrome differentiatiori. Funnel plot