中医药治疗特发性肺纤维化的系统评价再评价

Chinese Medicine for Idiopathic Pulmonary Fibrosis:An Overview of Systematic Reviews

目的对中医药治疗特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的系统评价(SRs)进行再评价。方法检索知网、中国生物医学数据库、维普、万方、The Cochrane Library、Web of Science、PubMed和EMbase数据库,纳入中医药治疗IPF的SRs,截止2021年5月。使用AMSTAR 2量表进行方法学质量评价,GRADE系统工具进行结局指标证据质量分级。结果共纳入28篇文献,试验组除辨证论治外,治疗方法集中在活血化瘀、补肺益气等方面,基本符合治疗法则。结果显示中医药治疗IPF可以提高有效率、增加肺功能、提高PaO_(2)、增加6WMD、缓解临床症状、提高患者的生活质量等。AMSTAR 2量表评价,所纳入SRs均有多项关键条目不达标,整体方法学质量等级不高。采用GRADE工具进行质量分级,一共234个结局指标,无高等证据质量,整体证据等级不高。结论中医药对比西医治疗IPF有效且不良反应不明显,但RCT研究和系统评价研究方法质量尚有缺陷,完全按照西医评价指标可能会低估真实结果,未来需要更规范的研究及适合中医的评价指标,对中医药研究的安全性方面关注还有待提高。

Objective To overview the systematic reviews(SRs)of Chinese medicine for idiopathic pulmonary fibrosis(IPF).Methods By searching the CNKI,CBM,VIP,WanFang Data,The Cochrane Library,Web of Science,PubMed and EMbase,the SRs of Chinese medicine for IPF were channeled from establishment the database to May 2021.Two researchers separately conducted literature screening,data extraction,etc.AMSTAR 2 was used to assess the methodological quality and GRADE Profiler software was used to grade the outcome indicators.Result A total of 28SRs were included.Besides the therapy with syndrome differentiation of the test groups,the treatment methods included activating blood circulation to dissipate blood stasis and invigorating the lung and qi,basically conformed the treatment rules.The results were shown that Chinese medicine of IPF could improve the effective rates,increase lung function,increase PaO_(2),increase 6WMD,relieve clinical symptoms and improve the patients’quality of life.As many key items of the SRs did not meet the standards,for example,the overall methodological quality was not high by AMSTAR 2.234outcome indicators were included,no high-quality evidences.The overall level of evidences were not high by GRADE.Conclusion Current evidences show that Chinese medicine is effective in treating IPF and there are no obvious adverse reactions,but RCT,the methods of SRs and methodological quality have certain flaws,so they need to be improved.Due to the mixed factors of Chinese medicine,completely following the western medical evaluation indicators may underestimate the true results.In the future,more standardized researchs and evaluation indicators suitable for Chinese medicine will be needed and the safety of Chinese medicine research needs to be improved.