从痰瘀论治慢性阻塞性肺疾病稳定期随机对照试验的系统评价和Meta分析

Treating COPD at Stable Stage from Phlegm and Blood Stasis: A Meta - analysis

目的:系统评价从痰瘀论治慢性阻塞性肺疾病(COPD)稳定期的疗效。方法:通过计算机检索中国期刊全文数据库(CNKI)、万方数据库、中文科技期刊数据库(VIP)、PubMed及Cochrane图书馆,检索时限均为从建库至2012年。按纳入及排除标准收集文献,提取数据及评价质量,并采用RevMan 5.1软件进行Meta分析。结果:最终共纳入9篇随机对照的文献。Meta分析结果显示:从痰瘀论治COPD稳定期的试验组临床总有效率优于未从痰瘀论治的对照组[RR=1.22,95%CI(1.11,1.34),P<0.0001];COPD稳定期从痰瘀论治能改善FVC值[MD=0.14,95%CI(0.10,0.18),P<0.00001]、FEV1/FVC值[MD=3.74,95%CI(0.61,6.88),P=0.02]及FEV1%值[MD=5.07,95%CI(0.93.30,9.22),P=0.02];COPD稳定期从痰瘀论治能改善咳嗽积分[MD=-0.43,95%CI(-0.62,-0.23),P<0.0001]、咯痰积分[MD=-0.28,95%CI(-0.46,-0.09),P=0.003]及喘息积分[MD=-0.35,95%CI(-0.60,-0.11),P=0.005]。结论:COPD稳定期从痰瘀论治能提高临床有效率、改善肺功能及临床症状,但由于纳入的随机对照试验数量较少、质量偏低,可能会影响评价结果,因此本系统评价结果尚需要更多高质量、大样本、多中心的随机对照试验进一步验证。

Objective ： To evaluate the efficacy of treating COPD at stable stage from phlegm and blood stasis. Methods ： All the related data was collected by using computer to search CNKI, VIP, Wanfang, PubMed and Cochrane library data base during the data base built to 2012. According to the inclusive and exclusive criteria to screen the studies ,the data was extracted. The quality was assessed and Meta - analysis was performed by RevMan 5.1 software. Results ： A total of 14 articles were included. The results of Meta - analysis demonstrated ： effective rate of treating COPD at stable stage from phlegm and blood stasis was higher than con-trol group [ RR = 1.22,95% CI（ 1.11,1.34）, P 〈 O. 0001 ] ; treating COPD at stable stage from phlegm and blood stasis could improve FVC [ MD =0.14,95% CI（0.10,0.18） ,P 〈 0. 00001 ], FEV1/FVC [ MD = 3.74,95% CI（0.61,6.88） ,P = O. 02 ] and FEV1% [ MD = 5.07,95% CI（0.93,9.22）,P = 0.02 ]; yreating COPD at stable stage from phlegm and blood stasis could re-duce the integral of cough [ MD = - O. 43,95 % CI （ - 0.62, - 0.23 ）, P 〈 0.0001 ], the integral of expectoration [ MD = - 0.28, 95% CI （ - 0.46, - O. 09）, P = O. 003 ] and the integral of dyspnea [ MD = - 0.35,95% CI （ - 0.60, - 0.11 ）, P = 0. 005 ]. Conclusion：Treating COPD at stable stage from phlegm and blood stasis could improve clinical effective rate, pulmonary function and clinical symptoms. However, the quantity and quality of the included studies in the review were small and lower, which could affect the result of the exact evaluation of the efficacy, so large sample, higher quality and multi-center trials were needed.