痰热清注射液治疗社区获得性肺炎随机对照试验的系统评价

Tanreqing Injection for community-acquired pneumonia:a systematic review of randomized evidence

目的:评价痰热清注射液治疗社区获得性肺炎(community-acquired pneumonia,CAP)的疗效和安全性。方法:收集痰热清注射液治疗CAP随机对照试验文献,纳入的文献按不同治疗策略进行分层,Jadad计分表评价纳入文献的质量,对纳入的试验作系统评价。结果:符合纳入标准的论文共12篇。Meta分析结果显示,痰热清与抗生素联合治疗组与抗生素治疗组相比,治愈率相对危险度(relativerisk,RR)为1.51,95%可信区间(confidence interval,CI)[1.29,1.77];显效率RR为1.31,95%CI[1.20,1.43];有效率RR为1.17,95%CI[1.11,1.23]。退热时间加权均数差(weighted mean difference,WMD)为-1.24,95%CI[-1.71,-0.76];咳嗽和咳痰显效率RR分别为1.42和1.27,95%CI[1.16,1.74]和[1.04,1.55];胸片阴影吸收RR为1.19,95%CI[1.09,1.30];中性粒细胞下降RR为1.10,95%CI[1.03,1.17]。两组上述各指标比较,差异均有统计学意义。未报道痰热清注射液临床应用相关的严重不良反应。结论:现有临床证据表明在抗生素及对症治疗基础上给予痰热清注射液治疗CAP可以明显提高临床疗效,并明显改善咳嗽咳痰症状,缩短发热时间,促进胸片阴影的吸收和血象恢复,未见明显的不良反应。由于纳入研究质量所限,尚需开展更多高质量的研究进一步分析。

Objective： To evaluate the efficacy and safety of Tanreqing Injection, a compound traditional Chinese herbal medicine, for community-acquired pneumonia. Methods： Literatures about randomized controlled trials of Tanreqing Injection for community-acquired pneumonia were reviewed. Related literatures were selected and analyzed according to different treatment strategies of the trials. The methodological quality of the trials was assessed by the Jadad scale, and evaluation was performed. Results： Twelve randomized controlled trials meeting the inclusion criteria were selected and reviewed. As Tanreqing combined group （Tanreqing Injection plus antibiotics and basic therapy） was compared with antibiotics group （antibiotics plus basic therapy）, the meta-analysis indicated that the relative risk （RR） for the total cure rate was 1.5], and 95% confidence interval （CI） was El. 29, 1. 771; RR for the total obvious effect rate was 1.31, and 95% CI was [-1.20,].43%; RR for the effective rate was 1. ]7, and 95% CI was [-1.11, 1.23]. The weighted mean difference （WMD） in disappearance time of fever between the two groups was --1.24, and 95% CI was [-1.7], -0.76]. The RR values between the two groups for the total obvious effect rate of cough and expectoration were 1.42 and 1.27, and 95% CIs were [-1.16, 1.74] and [-1.04, 1.55] respectively. The RR values between the two groups in absorption of chest X-ray shadow and neutrophil number were 1. 19, 1. 10 and 95% CIs were [1. 09, 1.30], [1.03, 1.17] respectively. The differences were all statistically significant. Serious systematic adverse reactions had not been reported in the trials. Conclusion： The effect of combined therapy with Tanreqing Injection plus antibiotics and basic therapy is better than that of antibiotics plus basic therapy. Tanreqing Injection can improve the symptoms of cough and expectoration, shorten the fever time and facilitate the absorption of chest X-ray shadow, without any significant adverse reactions. However, further high-quality trials are needed.