冬虫夏草治疗慢性阻塞性肺疾病临床疗效的系统评价

Cordyceps Sinensis for Chronic Obstructive Pulmonary Diseases:A Systematic Review

目的系统评价冬虫夏草治疗慢性阻塞性肺疾病的临床疗效。方法计算机检索CBM、CNKI、WanFang Data、VIP、PubMed、Cochrane Central Register of Controlled Trials(2013年第7期)以及EMbase,查找天然虫草或人工虫草制剂治疗慢性阻塞性肺疾病的随机或半随机对照试验。按照Cochrane系统评价方法筛选文献、提取资料并评价质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入14个半随机对照试验,1 162例患者。Meta分析结果显示:①人工虫草制剂+常规治疗组的总有效率优于常规治疗组[稳定期RR=1.33,95%CI(1.14,1.54),P=0.000 3;急性期RR=1.36,95%CI(1.14,1.62),P=0.000 8]。人工虫草制剂+常规治疗组对稳定期患者的肺功能指标FEV1/FVC[MD=5.48,95%CI(3.22,7.74),P<0.000 01]、FEV1%[MD=3.75,95%CI(0.91,6.59),P=0.010]以及6分钟步行试验[MD=43.51,95%CI(27.66,59.36),P<0.000 01]均有较好的改善作用。但尚缺乏报告血气分析、免疫功能和生存质量的研究,以及对急性期患者各项指标的报告。②1个研究结果显示,人工虫草制剂+常规治疗组与斯奇康+常规治疗组的总有效率无明显差异,前者的肺功能有更好的改善。结论现有证据表明,人工虫草制剂治疗慢性阻塞性肺疾病有一定效果,尤其可改善稳定期患者的肺功能和运动耐力,提高治疗总有效率。但纳入研究质量低,影响了合并结果的论证强度。今后尚需进一步开展高质量、大样本的临床研究验证其临床效果。

Objective To systematically review the effectiveness and safety of cordyceps sinensis for chronic ob- structive pulmonary diseases （COPD）. Methods We electronically searched databases including CBM, CNKI, Wan- Fang Data, VIP, PubMed, Cochrane Central Register of Controlled Trials （Issue 7, 2013） and EMbase for randomized controlled trial （RCT） and quasi-RCTs on the effectiveness and safety of cordyceps sinensis for COPD. According to Cochrane methods, two reviewers independently screened literature, extracted data, assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results Fourteen quasi-RCTs involving 1 162 patients were included. The results of meta-analysis showed that： a） compared with routine treatment alone, cultured cordyceps sinensis in combination of routine treatment improved total effective rates （stationary stage： RR= 1.33, 95%CI 1.14 to 1.54, P=0.000 3; advanced period： RR=1.36, 95%CI 1.14 to 1.62, P=0.000 8）. Also cultured cordyceps sinensis in combination of routine treatment improved lung function （FEVJFVC： MD=5.48, 95%CI 3.22 to 7.74, P〈0.000 01; FEVa%： MD=3.75, 95%CI 0.91 to 6.59, P=0.010）, and prolonged exercise duration （MD=43.51, 95%CI 27.66 to 59.36, P〈0.000 01） for COPD patients in stationary stage. However, no evidence was found in blood gas analysis, immune function, and quality of life; and b） the results of one study showed that, cultured cordyceps sinensis in combination of routine treatment was compa- rable with immune regulator （BCG-PSY） in combination of routine treatment with regards to total effective rates, but it could better improve lung function of patients. Conclusion Current evidence suggests that cultured cordyceps sinensis is effective in treating COPD, especially in treating lung function and exercise duration of COPD patients in stationary stage and increasing total effective rates. However, the strength of evidence is affected by poor methodological quality of the included studies. High-quality trials with large sample size are needed to verify its clinical effects.