中成药胃复春联合西药对胃癌前病变的干预作用：一项系统评价与Meta分析

Chinese patent medicine Weifuchun combined with Western medicine for the intervention of gastric precancerous lesions: A systematic review and Meta-analysis

关键词:  胃复春  胃癌前病变  腺体萎缩  肠上皮化生  异型增生  Meta分析  中西医结合疗法

Key words:  Weifuchun  gastric precancerous lesions  glandular atrophy  intestinal metaplasia  dysplasia  Meta-analysis  integrated traditional Chinese and Western medicine therapy

摘要:

目的 胃癌前病变是胃癌发生发展的关键阶段，以腺体萎缩、肠上皮化生、异型增生为核心渐进性病理改变。常规西药仅能缓解患者上腹不适等症状，控制局部炎症，对上述核心病理改变的逆转作用有限，难以满足阻断癌变进程的临床需求。中成药胃复春是防治极早期胃癌的常用中成药，但现有研究多为单中心、小样本随机对照试验（RCT），循证证据等级不足，缺乏系统性评价。方法 本研究遵循《Cochrane干预措施系统评价手册》及PRISMA2020声明开展系统评价。系统检索中英文数据库（截至2026年3月），纳入中成药胃复春联合常规西药对比单用同方案西药治疗胃癌前病变状态的RCT。由两名研究者独立完成文献筛选、数据提取及偏倚风险评估。采用R 4.3.3软件进行Meta分析。对主要结局进行敏感性分析、亚组分析及发表偏倚检验。对存在发表偏倚的结局指标，进一步采用剪补法进行校正，以验证结果的稳健性。结果 共纳入13项RCTs，涉及1 394例患者。Meta分析结果表明，中成药胃复春联合西药在改善腺体萎缩（SMD=-1.78，95%CI：-2.22~-1.33，P < 0.001）和肠上皮化生（SMD= -2.05，95%CI：-2.79~-1.31，P < 0.001）方面的效果显著优于单用西药。两项研究提示其对异型增生亦具有改善作用。亚组分析表明，疗程≥8周对肠上皮化生的改善效果更为显著。发表偏倚检验提示部分结局存在小样本效应，经剪补法校正后结果仍具统计学意义，表明研究结论稳健可靠。结论 现有证据表明，中成药胃复春联合常规西药可有效干预胃癌前病变，不仅能缓解临床症状，还能逆转胃癌前病变的核心病理改变，为该病的中西医结合防治提供了安全有效的循证依据。但受纳入研究局限性（如样本量较小、单中心研究为主）影响，本研究结论仍需更多大样本、多中心、高质量且随访时间更长的RCT进一步验证。

Abstract:

Objective Gastric precancerous lesions are a pivotal stage in the occurrence and progression of gastric cancer, characterized by progressive core pathological changes including glandular atrophy, intestinal metaplasia, and dysplasia. Routine Western medicine can only relieve clinical symptoms such as upper abdominal discomfort in patients and control local inflammation, but has limited efficacy in reversing the above core pathological changes, which falls short of the clinical needs for halting the carcinogenic process. Chinese patent medicine Weifuchun is a commonly used Chinese patent medicine for the prevention and treatment of gastric precancerous lesions; however, existing studies are mostly single-center, small-sample randomized controlled trials (RCTs), with insufficient evidence grade and lack of systematic evaluation. Methods This study strictly followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA 2020 statement to conduct a systematic review. Chinese and English databases were systematically searched up to March 2026 to include RCTs comparing Chinese patent medicine Weifuchun combined with routine Western medicine versus the same regimen of Western medicine alone in the treatment of gastric precancerous lesions. Literature screening, data extraction and risk of bias assessment were independently completed by two researchers. Meta-analysis was performed using R software version 4.3.3. Sensitivity analysis, subgroup analysis and publication bias test were conducted for the primary outcomes. For outcome indicators with publication bias, the trim-and-fill method was further applied for correction to verify the robustness of the results. Results A total of 13 RCTs involving 1 394 patients were included. The results of Meta-analysis showed that Chinese patent medicine Weifuchun combined with Western medicine was significantly superior to Western medicine alone in improving glandular atrophy (SMD=-1.78, 95%CI: -2.22 to-1.33, P < 0.001) and intestinal metaplasia (SMD=-2.05, 95%CI: -2.79 to -1.31, P < 0.001). Two studies suggested that it also exerted an improving effect on dysplasia. Subgroup analysis showed that a treatment course of ≥8 weeks had a more significant improvement effect on intestinal metaplasia. Publication bias test indicated that small sample effect existed in partial outcomes, and the results still maintained statistical significance after correction by the trim-and-fill method, which demonstrated that the conclusion of this study was robust and reliable. Conclusion Current evidence indicates that Chinese patent medicine Weifuchun combined with routine Western medicine can effectively intervene in gastric precancerous lesions. It can not only relieve clinical symptoms, but also reverse the core pathological changes of gastric precancerous lesions, which provides a safe and effective evidence-based basis for the integrated traditional Chinese and Western medicine prevention and treatment of this disease. However, affected by the limitations of the included studies (such as small sample size and mainly single-center studies), the conclusion of this study still needs to be further verified by more large-sample, multi-center, high-quality RCTs with longer follow-up duration.