中药玉屏风颗粒治疗变应性鼻炎的Meta分析

Meta-analysis of traditional Chinese medicine Yupingfeng granules in the treatment of allergic rhinitis

目的分析与评价中药玉屏风颗粒治疗变应性鼻炎(AR)的临床价值。方法计算机检索Pub Med、Embase、Scopus、Cochrane Library、Web of Science、中国生物医学文献数据库、中国科学引文数据库、万方数据和中国知网等国内外主要学术文献数据库,检索内容为玉屏风颗粒治疗AR的随机对照试验,论文发表时间为1987年1月~2017年12月。对文献进行筛选,应用改良Jadad表进行质量评价,Review Manager 5.3进行数据处理。结果 19篇文献共1875例AR患者纳入研究,分为3组:单纯玉屏风颗粒治疗组,共95例;单纯西药治疗组,包括鼻用糖皮质激素、口服抗组胺药等抗过敏药物或以上几种药物联合应用,共880例;玉屏风颗粒结合西药治疗组,共900例。Meta分析显示:玉屏风颗粒结合西药与单纯西药治疗相比,总有效率高(OR=6.05,95%CI 4.32-8.48,P<0.00001),复发率降低(OR=0.21,95%CI 0.14-0.31,P<0.00001),不良事件发生率低(OR=0.44,95%CI 0.25-0.75,P=0.003),差异均有统计学意义。结论玉屏风颗粒结合西药(鼻用糖皮质激素、口服抗组胺药物等)与单纯西药治疗相比能明显改善AR患者的鼻部症状,减少复发,且安全性好,为AR的中西医结合治疗提供了一定的循证医学证据。

Objective To analyze and evaluate the clinical value of traditional Chinese medicine Yupingfeng granules（YPFG） for treating allergic rhinitis（AR）. Methods The randomized controlled trials（RCTs） about traditional Chinese medicine YPFG for AR patients between January 1987 and December 2017 were searched in Pub Med, Embase, Scopus, Cochrane Library, Web of Science,CMBdisc, CSCD, WANFANG DATA, and CNKI databases. Relavant articles on the basis of inclusion and exclusion standards were screened, and the quality of literatures was estimated by the new Jadad scale. Data processing was implemented with the Review Manager 5.3 software. Results 19 RCTs covering 1875 cases of AR patients in total were accepted. Patients were allocated to the YPFG group（n=95）, the western medicine group（n=880）, and YPFG combined with western medicine group（n=900）. Meta-analysis showed that the combination therapy of YPFG and western medicine for AR has significant advantages compared with the single western medicine therapy ： higher total effective rate（OR=6.05,95% CI 4.32-8.48,P〈0.00001）, lower recurrence rate（OR=0.21,95%CI 0.14-0.31,P〈0.00001）, and lower incidence of adverse events（OR=0.44,95% CI 0.25-0.75,P=0.003）. Conclusion Comparing with the single use of western medicine, the combination therapy of YPFG and western medicine（nasal corticosteroids and oral antihistamines, etc.） can significantly improve the nasal symptoms and reduce the risk of recurrence in AR patients, and is safer. It provides certain evidence for the integrated therapy of traditional Chinese and western medicine in the treatment of AR.