[논문]고지혈성 급성 췌장염에 대한 대시호탕의 효과 : 체계적 문헌고찰과 메타분석

김윤정; 정유진; 박동일

doi:10.22246/jikm.2020.41.3.306

고지혈성 급성 췌장염에 대한 대시호탕의 효과 : 체계적 문헌고찰과 메타분석
The Effect of Dachaihu Decoction for Hyperlipidemic Acute Pancreatitis: A Systematic Review and Meta-Analysis 원문보기

대한한방내과학회지 = The journal of internal Korean medicine, v.41 no.3, 2020년, pp.306 - 325

김윤정 (동의대학교 부속한방병원 한방내과학) , 정유진 (동의대학교 부속한방병원 한방내과학) , 박동일 (동의대학교 부속한방병원 한방내과학)

Abstract ▼ AI-Helper

Objectives: The aim of this study is to investigate the effect of a Dachaihu decoction for hyperlipidemic acute pancreatitis (HLAP) by systematic review and meta-analysis of Chinese clinical studies. Methods: China National Knowledge Infrastructure (CNKI) was utilized as the major search engine. The date of the literature search was March 7, 2020. Randomized controlled trials (RCTs) about using a Dachaihu decoction for HLAP were included in this study. Meta-analysis was performed by synthesizing outcome data, including total effective rate, abdomen pain relief time, first bowel movement time, blood amylase recovery time, and triglyceride (TG) levels (mmol/L). The selected literature was assessed using Cochrane's risk of bias (RoB). Results: Twelve of 44 RCTs met the inclusion criteria. Most studies were evaluated with RoB as having unclear risk. The total effective rate of herbal medicine treatment based on the Dachaihu decoction was significantly higher than that of symptomatic supportive treatment in 10 articles (risk ratio=1.15, 95% CI: 1.08 to 1.21, p<0.00001, I2=0%). Herbal medicine treatment based on a Dachaihu decoction was significantly more effective than symptomatic supportive treatment in terms of reducing abdomen pain relief time (in all articles; mean difference=-1.70, 95% CI: -1.91 to -1.41, p<0.00001, I2=45%), first bowel movement time (in 7 articles; mean difference=-1.46, 95% CI: -1.86 to -1.05, p<0.00001, I2=73%), blood amylase recovery time (in 8 articles; mean difference=-1.48, 95% CI: -2.04 to -0.92, p<0.00001, I2=90%), and TG levels (in 8 articles; mean difference=-1.59, 95% CI: -2.28to -0.91, p<0.00001, I2=90%). Only one article reported side effects of treatment among the intervention group and control group, citing pancreatic ulcer and pancreatic pseudocyst formation. Conclusions: This study suggests that herbal medicine treatment based on a Dachaihu decoction could yield higher efficacy for HLAP than symptomatic supportive treatment alone. However, the results might be somewhat biased because of the poor quality and small sample size of the included RCTs. Well-qualified clinical studies are needed to prove the effectiveness of Dachaihu decoction therapy for HLAP.

주제어

질의응답

핵심어	질문	논문에서 추출한 답변
	고지혈성 급성 췌장염이란?	고지혈성 급성 췌장염은 고지혈증이 원인이 되어 발생하는 췌장의 급성 염증성 질환이다1 . 급성 췌장염은 알코올과 담석이 주요 요인으로 작용하지만, 생활 방식의 서구화(지방 섭취 과다, 과식 및 운동부족)로 인하여 고지혈증이 세 번째 주요 원인이 되고 있다2 .
	급성 췌장염의 주요 요인들로는 무엇들이 있는가?	고지혈성 급성 췌장염은 고지혈증이 원인이 되어 발생하는 췌장의 급성 염증성 질환이다1 . 급성 췌장염은 알코올과 담석이 주요 요인으로 작용하지만, 생활 방식의 서구화(지방 섭취 과다, 과식 및 운동부족)로 인하여 고지혈증이 세 번째 주요 원인이 되고 있다2 . 고지혈성 급성 췌장염은 급성 췌장염의 10% 이상을 차지한다3 .
	고지혈성 급성 췌장염의 기전은 어떻게 보고있는가?	고지혈성 급성췌장 염의 병태생리학적 기전은 아직 정확하게 밝혀지지 않았다. 중성지방(Triglyceride, TG)의 대사산물인 고농도의 유리 지방산(Free fatty acid, FFA)이 췌장의 선포세포와 혈관 내피의 손상을 유발하여 비활성화된 전구체 형태로 존재해야 하는 췌장 합성 소화효소를 췌장 내에서 활성화시키거나 TG의 분해 증가로 생성된 고농도의 카일로마이크론(Chylomicron) 이 모세혈관의 폐색을 일으켜, 췌장에 염증이 발생하고 췌장 조직 허혈성 괴사가 발생할 것이라고 보고 있다4.

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