中药治疗肝衰竭肠源性内毒素血症疗效的Meta分析OA
Meta-analysis on the Efficacy of Traditional Chinese Medicine in the Treatment of Intestinal Endotox-emia in Liver Failure
目的 系统评价中医药治疗肝衰竭肠源性内毒素血症的疗效.方法 计算机检索中国知网、万方数据库、维普数据库、PubMed、Web of Science和the Cochrane Library等数据库,建库至2025年11月12日收录的中药治疗肝衰竭肠源性内毒素血症的随机对照试验,运用RevMan 5.3软件进行数据统计分析.结果 最终纳入20篇文献,Meta分析结果显示:中药复方干预在临床显效人数[OR=2.29,95％CI(1.77,2.96),P＜0.000 01]和无效人数[OR=0.33,95％CI(0.24,0.46),P＜0.000 01]上,与对照组相比差异有统计学意义.同时中药复方可显著降低白细胞介素-6[SMD=-1.29,95％CI(-1.83,-0.76),P＜0.000 01]、肿瘤坏死因子-α[SMD=-1.37,95％CI(-1.88,-0.85),P＜0.000 01]、内毒素[SMD=-1.01,95％CI(-1.54,-0.47),P=0.000 2]、谷丙转氨酶[SMD=-0.93,95％CI(-1.39,-0.47),P＜0.000 1]、谷草转氨酶[SMD=-1.26,95％CI(-1.73,-0.79),P＜0.000 01]、总胆红素[OR=-1.09,95％CI(-1.50,-0.68),P＜0.000 01]、二胺氧化酶[SMD=-1.85,95％CI(-2.66,-1.04),P＜0.000 01]、白细胞介素-1[SMD=-1.07,95％CI(-1.51,-0.64),P＜0.000 01]、白细胞介素-8[SMD=-2.24,95％CI(-2.93,-1.55),P＜0.000 01]、尿乳果糖/甘露醇[MD=-0.18,95％CI(-0.20,-0.16),P＜0.000 01]、中医证候积分[SMD=-1.74,95％CI(-2.47,-1.01),P＜0.000 01]、D-乳酸[SMD=-1.84,95％CI(-2.59,-1.09,P＜0.000 01]、血氨[SMD=-1.78,95％CI(-2.73,-0.82),P=0.000 3]水平,提高凝血酶原活动度[SMD=1.36,95％CI(0.90,1.81),P＜0.000 01]、白蛋白[SMD=0.20,95％CI(0.07,0.33),P=0.002]水平,差异均有统计学意义.结论 对于肝衰竭肠源性内毒素血症患者,使用中医药干预可以提高临床有效率,降低无效风险,保护肝功能、抑制炎症指标的升高.
Objective:To systematically evaluate the efficacy of traditional Chinese medicine(TCM)in the treat-ment of intestinal endotoxemia in patients with liver failure.Methods:Databases including CNKI,Wanfang Data,VIP,PubMed,Web of Science and the Cochrane Library were searched electronically from inception to November 12,2025.RevMan 5.3 software was used for statistical analysis.Results:A total of 20 randomized controlled trials(RCTs)were included.Meta-analysis results showed that there were statistically significant differences between the TCM compound intervention group and the control group in the number of clinically effective cases[OR=2.29,95％CI(1.77,2.96),P＜0.000 01]and the number of non-effective cases[OR=0.33,95％CI(0.24,0.46),P＜0.000 01].Additionally,the Chinese herbal compound significantly reduced the levels of interleukin-6[SMD=-1.29,95％CI(-1.83,-0.76),P＜0.000 01],tumor necrosis factor-α[SMD=-1.37,95％CI(-1.88,-0.85),P＜0.000 01],endotoxin[SMD=-1.01,95％CI(-1.54,-0.47),P=0.000 2],alanine aminotransferase[SMD=-0.93,95％CI(-1.39,-0.47),P＜0.000 1],aspartate aminotransferase[SMD=-1.26,95％CI(-1.73,-0.79),P＜0.000 01],total bilirubin[OR=-1.09,95％CI(-1.50,-0.68),P＜0.000 01],diamine oxidase[(SMD=-1.85,95％CI(-2.66,-1.04),P＜0.000 01],interleukin-1[SMD=-1.07,95％CI(-1.51,-0.64),P＜0.000 01],interleukin-8[SMD=-2.24,95％CI(-2.93,-1.55),P＜0.000 01],urinary lactulose/mannitol ratio[MD=-0.18,95％CI(-0.20,-0.16),P＜0.000 01],TCM syndrome score[SMD=-1.74,95％CI(-2.47,-1.01),P＜0.000 01],D lactate[SMD=-1.84,95％CI(-2.59,-1.09),P＜0.000 01],and blood ammonia[SMD=-1.78,95％CI(-2.73,-0.82),P=0.000 3],while increasing the levels of prothrombin activity[SMD=1.36,95％CI(0.90,1.81),P＜0.000 01]and albumin[SMD=0.20,95％CI(0.07,0.33),P=0.002].All these differences were statistically significant.Conclusion:For patients with liver failure complicated with intestinal endotoxemia,TCM intervention can improve the total clinical effective rate,reduce the risk of ineffectiveness,protect liver function and inhibit the elevation of inflammatory indi-cators.
冯荣;史英;冯阳;单瑞琪;曾大凌;刘金响
陕西中医药大学,陕西咸阳 712000陕西中医药大学第二附属医院,陕西咸阳 712000西北大学附属西安市第三医院,陕西西安 710127陕西中医药大学,陕西咸阳 712000陕西中医药大学,陕西咸阳 712000陕西中医药大学第二附属医院,陕西咸阳 712000
医药卫生
肠源性内毒素血症肝衰竭中药疗效Meta分析
Intestinal endotoxemiaLiver failureChinese materia medicaEfficacyMeta-analysis
《中国中医急症》 2026 (5)
503-510,8
国家自然科学基金项目(82204877)陕西省中医药科技创新提质扩能计划(TZKN-CXPT-03)
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