中西医结合治疗痰热郁肺型AECOPD有效性的贝叶斯网状Meta分析

Effectiveness of integrated traditional Chinese and western medicine in treating AECOPD with phlegm-dampness stagnating in the lung syndrome:a Bayesian network meta-analysis

目的基于贝叶斯网状Meta分析,评价中西医结合治疗痰热郁肺型慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法计算机检索PubMed、Web of Science、EMBASE、Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台(WanFang Data)、维普中文期刊服务平台(VIP)等数据库中关于中西医结合治疗痰热郁肺型AECOPD的随机对照研究。文献发表时间为建库至2019年8月,按纳入标准筛选文献后提取资料,采用Review Manager 5.3、Stata 14.0和R 3.5.1软件进行文献评价和数据分析。结果本研究共纳入19篇文献,累计研究对象1486例,涉及3种中药方剂(清金化痰汤、苇茎汤、桑白皮汤)。网状Meta分析结果显示,与西医常规治疗相比,清金化痰汤+西医常规治疗[RR=3.54,95%CI(1.45,8.22)]、苇茎汤+西医常规治疗[RR=4.34,95%CI(2.16,8.72)]、桑白皮汤+西医常规治疗[RR=3.39,95%CI(2.11,5.67)]均具有显著的临床有效性。以临床有效性和肺功能为评价指标进行排序,结果显示中西医结合用药中的中药方剂,以苇茎汤对AECOPD的疗效最佳。结论与单纯采用西医常规治疗相比,中西医结合治疗痰热郁肺型AECOPD疗效满意,苇茎汤+西医常规治疗可能为最佳方案;但因纳入的研究质量不高,确切结论仍需更多高质量的临床研究验证。

Objective To evaluate the clinical efficacy of integrated traditional Chinese and western medicine in treating acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with phlegm-heat stagnating in the lung syndrome based on a Bayesian network meta-analysis.Methods Randomized controlled trials(RCTs)of integrated traditional Chinese and western medicine in the treatment of AECOPD with phlegm-dampness stagnating in the lung syndrome published in Pub Med,Web of Science,EMBASE and Cochrane Library,China national knowledge infrastructure(CNKI),WanFang,VIP,SinoMed(CBM)databases were searched from the establishment of each database up to August 2019.Data were extracted after the collected literatures were screened according to the inclusion criteria,and quality assessment and data analysis were conducted by Review Manager 5.3,Stata14.0 and R 3.5.1.Results A total of 19 RCTs were included in our study with a cumulative total of 1,486 cases,involving three Chinese herbal formulas(Qingjin Huatan Decoction,Weijing Decoction,and Sangbaipi Decoction).According to the results of network meta-analysis,statistically significant clinical effectiveness was observed in cases treated with Qingjin Huatan Decoction and conventional western medicine[RR=3.54,95%CI(1.45,8.22)],cases treated with Weijing Decoction and conventional western medicine[RR=4.34,95%CI(2.16,8.72)],and cases treated with Sangbaipi Decoction and conventional western medicine[RR=3.39,95%CI(2.11,5.67)]compared with that in cases treated with conventional western medicine alone.The clinical effectiveness and pulmonary function were used as evaluation indexes.The results showed that among the three traditional Chinese medicine formulas,Weijing Decoction had the best therapeutic effect on AECOPD.Conclusion Compared with conventional western medicine treatment alone,the integrated traditional Chinese and western medicine treatment has shown more satisfactory therapeutic results in treating AECOPD with phlegm-damp stagnating in the lung syndrome,and the combined use of Weijing Decoction and convention western medicine treatment may be the best treatment protocol.However,due to the low quality of the included studies,the exact conclusions still need to be verified by more high-quality clinical studies.