中药结合常规药物治疗慢性阻塞性肺疾病急性加重期疗效的系统评价与meta分析

Guo Wen, L I Xuanlin, Zhao Hulei, Lei Siyuan, Xie Yang, L I Jiansheng
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摘要

目的:通过高质量的随机安慰剂对照试验,系统评价中药联合西药治疗慢性阻塞性肺疾病(AECOPD)急性加重期的疗效和安全性。方法:检索PubMed、Embase、Cochrane图书馆、中国国家知识基础设施数据库、中国生物医学文献数据库、中国科技期刊数据库和万方数据库,检索自成立至2021年6月4日的中西医结合治疗AECOPD的随机安慰剂对照试验。Cochrane协作的工具和推荐、评估、发展和评价的分级被用来评估纳入研究的偏倚风险和证据质量。采用Revman 5.3软件进行meta分析。结果:共纳入9项试验,1591例患者。meta分析显示,在CWM治疗基础上,中药组在改善临床总有效率[= 1.29,95%(1.07,1.56),= 0.007,低质量]、中医症状评分[= -2.99,95%(-4.46,-1.53),< 0.0001,中等质量]、改善动脉血气结果[PaO: = 4.51, 95%(1.97, 7.04), = 0.0005,中等质量]、改善动脉血气结果[PaO: = 4.51, 95% (1.97, 7.04), = 0.0005;PaCO: = -2.87, 95%(-4.28, -1.46), < 0.0001,中等质量),降低CAT评分[= -2.08,95%(-2.85,-1.31),< 0.00001,中等质量],住院时间[= -1.87,95%(-3.33,-0.42),= 0.01,中等质量],急性加重率[= 0.60,95%(0.43,0.83),= 0.002,中等质量]。没有严重的chm相关不良事件的报道。结论:目前的证据表明,CHM是AECOPD患者接受CWM的有效且耐受性良好的辅助治疗。然而,考虑到高异质性,这一结论需要证实。
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Effectiveness of Chinese herbal medicine combined with conventional medicine on acute exacerbation of chronic obstructive pulmonary disease: a systematic review and Meta-analysis.

Objective: To systematically evaluate the efficacy and safety of Chinese herbal medicine (CHM) combined with conventional Western Medicine (CWM) on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on high-quality randomized placebo-controlled trials.

Methods: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, and Wanfang databases for randomized placebo-controlled trials of CHM treatment for AECOPD from inception to June 4, 2021. The Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development and Evaluation were used to assess the risk of bias and the evidence quality of the included studies. Revman 5.3 software was used for Meta-analysis.

Results: A total of 9 trials involving 1591 patients were included. The Meta-analysis showed that based on CWM treatment, CHM group had significant advantages over the placebo group in ameliorating clinical total effective rate [ = 1.29, 95% (1.07, 1.56), = 0.007, low quality] and TCM symptom scores [ = -2.99, 95% (-4.46, -1.53), < 0.0001, moderate quality], improving arterial blood gas results [PaO: = 4.51, 95% (1.97, 7.04), = 0.0005, moderate quality; PaCO: = -2.87, 95% (-4.28, -1.46), < 0.0001, moderate quality], reducing CAT scores [ = -2.08, 95% (-2.85, -1.31), < 0.000 01, moderate quality],length of hospitalization [ = -1.87, 95% (-3.33, -0.42), = 0.01, moderate quality], and acute exacerbation rate [ = 0.60, 95% (0.43, 0.83), = 0.002, moderate quality]. No serious CHM-related adverse events were reported.

Conclusions: The current evidence indicates that CHM is an effective and well-tolerated adjunct therapy for AECOPD patients receiving CWM. However, considering the high heterogeneity, this conclusion requires confirmation.

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