艾灸與西藥治療慢性萎縮性胃炎療效比較的Meta分析

柯天行健 李國娜 李琪 吳楚婷 吳煥淦 馬曉芃 鄭詩雨 陳炳力 王照欽 許峰 李璟

摘要 目的：評價艾灸與西藥治療慢性萎縮性胃炎（CAG）的臨床療效及安全性。方法：計算機檢索Pubmed、Cochrane Library、Embase、Web of Science、國家知識基礎設施數(shù)據庫（CNKI）、中文科技期刊數(shù)據庫（CCD）、中國學術期刊數(shù)據庫（CSPD）、中國生物醫(yī)學文獻數(shù)據庫（CBM）中有關艾灸對比西藥治療CAG的臨床隨機對照試驗，檢索時間均從建庫至2021年10月31日，根據本研究設定的納排標準篩選文獻并提取資料。采用“Cochrane偏倚風險評估工具”對納入文獻進行質量評價，采用“RevMan 5.4.1”軟件對數(shù)據進行分析。結果：最終納入13篇RCT，共計1 062名CAG受試者，但總體納入文獻質量不高。Meta分析結果顯示，艾灸治療在改善CAG患者的臨床有效率優(yōu)于西藥組。在改善臨床癥狀方面，艾灸治療緩解CAG患者胃脘灼痛、胃脘脹滿、胃脘痞悶評分方面均優(yōu)于西藥組;在改善胃腸分泌蛋白方面，艾灸改善胃蛋白酶原Ⅰ（PG Ⅰ） /PG Ⅱ、G-17水平優(yōu)于西藥組;然而艾灸與西藥在改善胃黏膜胃鏡有效率、胃鏡下及病理評分方面差異無統(tǒng)計學意義。結論：艾灸治療CAG的療效優(yōu)于西藥，但受納入文獻質量及數(shù)量的局限性，驗證艾灸治療CAG的療效仍需更多高質量研究。

關鍵詞 慢性萎縮性胃炎;艾灸;療效;系統(tǒng)評價;Meta分析

Efficacy of Moxibustion Versus Western Medicine for Chronic Atrophic Gastritis：A Meta-analysis

KE Tianxingjian1，LI Guona2，LI Qi2，WU Chuting3，WU Huangan2，3，MA Xiaopeng2，3，ZHENG Shiyu2，CHEN Bingli2，WANG Zhaoqin3，XU Feng4，LI Jing2

（1 Longhua Hospital，Shanghai University of Traditional Chinese Medicine，Shanghai 200032，China; 2 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine，Shanghai University of Traditional Chinese Medicine，Shanghai 200437，China; 3 Shanghai Research Institute of Acupuncture and Meridian，Shanghai 200030，China; 4 Shanghai Qigong Research Institute，Shanghai University of Traditional Chinese Medicine，Shanghai 200030，China）

Abstract Objective：To evaluate the clinical efficacy and safety of moxibustion and western medicine in the treatment of chronic atrophic gastritis （CAG）.Methods：Clinical randomized controlled trials （RCTs） on the comparison of moxibustion and western medicine in treating CAG were retrieved from the databases including PubMed，Cochrane Library，Embase，Web of Science，CNKI，CCD，CSPD，and CBM from database inception to October 31st，2021.The research papers were screened out and data were extracted according to the set inclusion and exclusion criteria.The Cochrane risk-of-bias tool was used to evaluate the quality of included papers，and the RevMan 5.4.1 was used for data analysis.Results：Thirteen RCTs were included，involving 1 062 patients with CAG，but the overall quality of the included RCTs was not high.As revealed by Meta-analysis results，the clinical effective rate of moxibustion in the treatment of CAG was higher than that of western medicine.In terms of improving clinical symptoms，moxibustion was superior to western medicine in alleviating epigastric burning pain，epigastric fullness，and epigastric stuffiness of CAG patients.In terms of improving gastrointestinal protein，moxibustion was superior to western medicine in improving PG I/PG II and G-17 levels.However，there was no significant difference between moxibustion and western medicine in improving gastroscopic efficiency，and gastroscopic and pathological scores of the gastric mucosa.Conclusion：The efficacy of moxibustion in the treatment of CAG is better than that of western medicine.However，due to the limitations of the quality and quantity of the included RCTs，more high-quality studies are needed to verify the efficacy of moxibustion in the treatment of CAG.

Keywords Chronic atrophic gastritis; Moxibustion; Efficacy; Systematic review; Meta-analysis

中圖分類號：R246.1;R573.3文獻標識碼：Adoi：10.3969/j.issn.1673-7202.2022.03.008

慢性萎縮性胃炎（Chronic Atrophic Gastritis，CAG）是以胃黏膜固有腺體減少或消失為特點的消化系統(tǒng)常見疾病，臨床以上腹部飽脹、疼痛、反酸、嘈雜、噯氣、惡心、食欲不振等為主要表現(xiàn)[1]。幽門螺旋桿菌（Helicobacter Pylori，Hp）感染、膽汁反流、自身免疫功能障礙均可導致CAG的發(fā)生[2]，其中以Hp感染導致的胃體胃炎及自身免疫功能受損導致的胃體及胃底胃炎多見[3]。……