内科

目的基于Meta分析探讨柴黄清胰活血颗粒联合常规西医治疗对急性胰腺炎（AP）的疗效。方法检索中国知网、万方、重庆维普、PubMed、Embase、Web of Science、The Cochrane Library等数据库，收集自建库至2025年3月31日的柴黄清胰活血颗粒联合常规西医治疗AP的随机对照研究，提取相关数据并进行文献质量评价后，采用RevMan 5.3软件进行Meta分析。结果共纳入8篇文献，涉及502例患者，其中观察组（接受柴黄清胰活血颗粒联合常规西药治疗）258例，对照组（仅接受常规西药治疗）244例。Meta分析结果显示：柴黄清胰活血颗粒联合常规西医治疗AP在提高临床总有效率（RR=1.24，95%CI：1.11～1.39，P<0.0001），降低急性生理与慢性健康Ⅱ（APACHE Ⅱ）评分（MD=-5.85分，95%CI：-8.49～-3.20，P<0.0001），降低肿瘤坏死因子（TNF）-α（MD=-40.92 pg/mL，95%CI：-44.51～-37.32，P<0.00001）、白细胞介素（IL）-6（MD=-19.68 pg/mL，95%CI：-29.13～-10.23，P<0.0001）、IL-8（MD=-27.37 pg/mL，95%CI：-54.05～-0.69，P=0.04）、IL-18（MD=-67.11 pg/mL，95%CI：-72.85～-61.37，P<0.00001）等炎症因子水平，降低AP患者症状量化评分（MD=-0.65分，95%CI：-1.01～-0.29，P=0.0004）、体征量化评分（MD=-0.79分，95%CI：-1.19～-0.40，P<0.0001）方面优于单用西药治疗；但在降低血清淀粉酶（MD=-19.30 U/L，95%CI：-54.07～15.46，P=0.28）、血小板活化因子（MD=-0.54 ng/mL，95%CI：-1.72～0.63，P=0.36）水平方面，两种疗法差异均无统计学意义（均P>0.05）。结论柴黄清胰活血颗粒联合西医治疗在改善AP临床症状、控制炎症反应方面具有显著优势，但对部分生化指标的调控作用仍需进一步研究验证。受纳入研究数量和质量限制，上述结论需谨慎解读，未来需要更多高质量、大样本、多中心的随机对照试验进一步验证。

Objective To explore the efficacy of Chaihuang Qingyi Huoxue Granules combined with conventional Western medicine on acute pancreatitis (AP) through a Meta‑analysis. Methods Randomized controlled trials on Chaihuang Qingyi Huoxue Granules combined with conventional Western medicine for AP were retrieved from CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, and The Cochrane Library from inception to March 31st, 2025. After relevant data extraction and quality appraisal of included studies, Meta‑analysis was performed with RevMan 5.3 software. Results A total of 8 studies involving 502 patients were included, with 258 patients in the observation group (treated by Chaihuang Qingyi Huoxue Granules combined with conventional Western medicine) and 244 in the control group (treated by conventional Western medicine alone). Meta‑analysis results showed that, compared with Western medicine alone, Chaihuang Qingyi Huoxue Granules combined with conventional Western medicine significantly improved the overall clinical effective rate (RR=1.24, 95% CI: 1.11 to 1.39, P<0.0001), reduced acute physiology and chronic health evaluation Ⅱ scores (MD=-5.85 points, 95% CI: -8.49 to -3.20, P<0.0001), lowered inflammatory factors levels including tumor necrosis factor‑α (MD=-40.92 pg/mL, 95% CI: -44.51 to -37.32, P<0.00001), interleukin(IL)‑6 (MD=-19.68 pg/mL, 95% CI: -29.13 to -10.23, P<0.0001), IL‑8 (MD=-27.37 pg/mL, 95% CI: -54.05 to -0.69, P=0.04), and IL‑18 (MD=-67.11 pg/mL, 95% CI: -72.85 to -61.37, P<0.00001), and decreased quantitative scores of symptom (MD=-0.65 points, 95% CI: -1.01 to -0.29, P=0.0004) and quantitative scores of physical signs (MD=-0.79 points, 95% CI: -1.19 to -0.40, P<0.0001). However, no statistically significant differences were observed between the two groups in reducing serum amylase (MD=-19.30 U/L, 95% CI: -54.07 to 15.46, P=0.28) or platelet‑activating factor (MD=-0.54 ng/mL, 95% CI: -1.72 to 0.63, P=0.36) levels. Conclusion Chaihuang Qingyi Huoxue Granules combined with Western medicine shows significant advantages in improving AP clinical symptoms and controlling inflammatory responses, but its regulatory effects on some certain biochemical indicators require further research validation. Due to the limitations in the number and quality of the included studies, the above conclusions should be interpreted with caution, and more high‑quality, large‑sample, multi‑center randomized controlled trials are needed for further confirmation in the future.