背景:中医认为脾胃气虚是慢性萎缩性胃炎的基本病机。健脾补气是治疗的基本原则。四君子汤是补脾补气的根本疗法。
方法:Cochrane图书馆,中国国家知识基础设施中国生物医学光盘,VIP,万方数据库,WebofScience,PubMed,和Embase检索了从数据库开始到2023年6月3日发表的相关随机对照试验.文献筛选和数据提取由2名独立研究者执行。利用Cochrane协作工具评估纳入研究的质量。利用Stata15进行Meta分析。
结果:本分析纳入了32项2780名患者的研究。分析结果揭示,与西医治疗相比,加味四君子汤可显著提高临床疗效(相对危险度[RR]=1.241,95%置信区间[95%CI]=1.199-1.285,P<.0001),降低症状评分(标准化均差[SMD]=-1.846,95%CI=-2.160至-1.532,P<.00001)和胃镜病理评分(SMD=-1.122,95%CI=-1.492至-0.752,P<.00001),生活质量改善(SMD=4.294,95%CI=2.982-5.606,P<.00001),幽门螺杆菌根除率增加(RR=1.297,95%CI=1.035-1.625,P<.001),胃蛋白酶原I水平(SMD=2.615,95%CI=2.344-2.886,P<.00001),胃蛋白酶原I/II比值(SMD=3.107,95%CI=2.811-3.403,P<.00001),和胃泌素-17水平(SMD=1.004,95%CI=0.794-1.215,P<.00001),降低CAG患者的不良反应发生率(RR=0.361,95%CI=0.235-0.556,P<0.01),具有统计学上的显著差异。
结论:加味四君子汤治疗CAG的疗效优于常规西药。它被证明可以提高幽门螺杆菌的根除率,减少症状评分,提高生活质量,并改善胃蛋白酶原相关指标,具有较高的安全性。
BACKGROUND: Qi deficiency in the spleen and stomach is considered to be the fundamental pathogenesis of chronic atrophic gastritis (CAG) in Traditional Chinese medicine. Spleen strengthening and Qi replenishment are the basic treatment principles. Sijunzi Decoction serves as the fundamental remedy for spleen notification and Qi replenishment.
METHODS: The Cochrane Library, China National Knowledge Infrastructure China Biology Medicine disc, VIP, Wanfang Database, Web of Science, PubMed, and Embase were retrieved for related randomized controlled trials published from the inception of the databases to June 3, 2023. Literature screening and data extraction were executed by 2 independent investigators. The Cochrane Collaboration tool was leveraged to appraise the quality of included studies. Meta-analysis was implemented utilizing Stata 15.
RESULTS: This analysis incorporated 32 studies with 2780 patients. The analysis results unveiled that compared to Western medicine treatment, modified Sijunzi Decoction significantly enhanced the clinical efficacy (relative risk [RR] = 1.241, 95% confidence interval [95% CI] = 1.199-1.285, P < .0001), lowered symptom scores (standardized mean difference [SMD] = -1.846, 95% CI = -2.160 to -1.532, P < .00001) and gastroscopic pathological scores (SMD = -1.122, 95% CI = -1.492 to -0.752, P < .00001), ameliorated quality of life (SMD = 4.294, 95% CI = 2.982-5.606, P < .00001), increased the Helicobacter pylori eradication rate (RR = 1.297, 95% CI = 1.035-1.625, P < .001), pepsinogen I levels (SMD = 2.615, 95% CI = 2.344-2.886, P < .00001), pepsinogen I/II ratio (SMD = 3.107, 95% CI = 2.811-3.403, P < .00001), and gastrin-17 levels (SMD = 1.004, 95% CI = 0.794-1.215, P < .00001), and reduced the incidence of adverse reactions (RR = 0.361, 95% CI = 0.235-0.556, P < .01) in individuals with CAG, with statistically significant discrepancies.
CONCLUSIONS: Modified Sijunzi Decoction exhibited superior efficacy to conventional Western medicine in treating CAG. It was shown to improve the Helicobacter pylori eradication rate, reduce symptom scores, enhance quality of life, and improve pepsinogen-related indicators with a high safety profile.