丁彤晶 念家云 王笑民 张青

摘要 目的：系統评价中医药治疗慢性放射性肠炎的疗效。方法：采用计算机检索Cochrane Central、PubMed、EM-BASE、中国生物医学文献数据库（CBM）、国家知识基础设施数据库（简称中国知网，China National Knowledge Infrastructure，CNKI）、中文科技期刊数据库（简称维普资讯，Chinese Citation Database，CCD）、中国学术期刊数据库（简称万方数据库，China Science Periodical Database，CSPD），搜集中医药治疗慢性放射性肠炎的随机对照临床试验，由两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Rev Man5.3软件进行Meta分析。结果：筛选出文献207篇，根据文献纳排标准，排除189篇，最终纳入18项临床研究，1 427例患者，其中观察组724例，对照组703例。观察组患者临床有效率（RR=1.31，95%CI为1.25～1.39，P<0.000 01）高于对照组，观察组患者肠镜下黏膜损伤缓解率（RR=1.33，95%CI为1.08～1.65，P=0.008）较对照组为高，观察组在减少炎症介质、提高免疫功能、缩短治疗时间方面均优于对照组，差异有统计学意义（P<0.05），中医药组在提高生命质量水平方面优于西医组，差异有统计学意义（P<0.05）。结论：中医药可有效缓解慢性放射性肠炎患者腹痛、腹泻、便血、乏力等相关症状，且能有效促进肠黏膜的愈合。

关键词 中医药;慢性放射性肠炎;疗效;系统评价;文献检索;偏倚评估;亚组分析;随机对照

Meta-analysis of Traditonal Chinese Medicine in the Treatment of Chronic Radiation Enteritis

DING Tongjing1，2，NIAN Jia Yun1，WANG Xiaomin1，ZHANG Qing1

（1 Beijing Hospital of Traditional Chinese Medicine，Capital Medical University，Beijing 100010，China;

2 Beijing University of Traditional Chinese Medicine，Beijing 100029，China）

Abstract Objective：To systematically evaluate the efficacy of traditional Chinese medicine in the treatment of chronic radioactive enteritis.Methods：Cochrane Central，PubMed，EM-BASE，Chinese Biomedical Literature Database （CBM），Chinese Journal Full-text Database （CNKI），Weipu Chinese Science and Technology Journal Full-text Database （VIP），Wanfang Data Knowledge Service Platform （WANFANG DATA） were retrieved by computer and were used to collect a randomized controlled clinical trial of TCM for chronic radiation enteritis.After 2 researchers independently screened the literature，extracted data and evaluated the risk of bias included in the study，and Rev Man5.3 software was used for Meta analysis.Results：A total of 207 papers were selected，According to the literature，excluding 189 papers，18 clinical studies and 1 427 patients were adopted.Among these，there were 724 cases in the test group，and 703 in the control group.Meta analysis results：clinically effective rate of patients in the test group [RR=1.31，95%CI（1.25～1.39），P<0.000 01] higher than the control group，rate of intestinal mucosal injury in experimental group [RR=1.33，95%CI（1.08～1.65），P=0.008] higher than the control group.The remission rate of mucosal injury under colonoscopy in the test group [RR=1.33，95%CI（1.08～1.65），P=0.008] was higher than that of the control group.The test group was able to reduce pro-inflammatory factors，improve immune function，and shorten treatment time，and is better than the control group，and the difference is statistically significant （P<0.05）.Traditional Chinese medicine group was better than the Western medicine group in improving the quality of life，and the difference was statistically significant （P<0.05）.Conclusion：Based on the current research，Chinese medicine can effectively relieve abdominal pain，diarrhea，blood stool，fatigue and other related symptoms in patients with chronic radiation enteritis.It can effectively promote the healing of the intestinal mucosa.However，the current treatment schemes have large differences and the number of research documents is small.There is no uniform standard for TCM schemes.Therefore，higher quality research is still needed to confirm the treatment of TCM.The therapeutic effect of the disease，so as to provide evidence-based medicine for clinical evidence.a.

Keywords Chinese medicine; Chronic radiation enteritis; Efficacy; Systematic review; Literature search; Bias evaluation; Subgroup analysis; Randomized control

中图分类号：R242;R574文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.021

放射性肠炎（Radiation Enteritis，RE）是盆腔、腹腔及腹膜后肿瘤放射治疗后常见的一种放射性损伤[1]，临床上多表现为腹痛、腹泻、便次增多、黏液脓血便甚至鲜血便[2]，一般临床上根据肠道所受辐射剂量、时间及病情缓急的不同，将其分为急性和慢性2种。急性者往往发生于放疗期和放疗结束后2个月，甚至是放疗后半年内。而慢性期患者症状多绵延不愈或在放疗半年后出现[3]，症状往往反复难愈，且严重者还可出现出血、穿孔、梗阻等情况，严重影响了患者的生命质量。而目前慢性放射性肠炎尚无药物预防及治疗的标准策略，具备手术治疗机会的患者比例不足1/3，且手术的创伤性大、术后的并发症多，而且药物保留灌肠虽然可以在一定程度上缓解患者的相关症状，但其疗效却极为有限[4]。……