中药对百草枯中毒肺损伤动物模型干预作用的Meta分析

The efficacy of traditional Chinese medicin in animal model of lung injury induced by paraquat： a Meta-analysis

目的 系统评价中药在百草枯中毒肺损伤动物中的干预作用,为今后临床试验提供理论依据.方法 搜索万方数据库、中国知网CNKI、维普数据库、PubMed/MEDLINE、EMBASE 1979年1月至2012年9月发表的有关中药对百草枯中毒肺损伤动物干预作用的相关文献,按Cochrane系统评价方法筛选实验、提取资料,采用RevMan 5.0软件对符合纳入标准的文献进行荟萃分析（Meta分析）,均采用随机效应模型,得出合并后的加权均数差（WMD）及95％可信区间（95％CI）.结果 最终共纳入18篇文献,总计1 188只动物.Meta分析结果显示,中药干预能够改善百草枯中毒肺损伤动物的肺系数（WMD为-0.07,95％CI为-0.14～-0.01,P=0.03）,降低肺湿/干质量比值（WMD为-1.15,95％CI为-2.03 ～-0.27,P=0.01）,提高血浆超氧化物歧化酶（SOD）含量（WMD为56.08,95％ CI为23.46～88.70,P=0.000 8）,改善谷胱甘肽过氧化物酶（GSH-Px）水平（WMD为26.64,95％CI为18.95～34.33,P＜0.000 01）,降低肺组织丙二醛（MDA）含量（WMD为-0.65,95％CI为-1.00 ～-0.30,P=0.000 2）;但中药干预对炎症因子肿瘤坏死因子-α（TNF-α）、羟脯氨酸（HYP）的影响与对照组比较差异无统计学意义,其中TNF-α的WMD为-25.15,95％CI为-54.87～4.57,P=0.10;HYP的WMD为-1.11,95％CI为-2.71 ～ 0.48,P=0.17.结论 中药干预治疗对百草枯中毒肺损伤动物具有一定的保护作用,但数据存在较大的异质性,故仍需进一步验证.

Objective To systematically review the effect of traditional Chinese medicine （TCM） in an animal model of lung injury induced by paraquat （PQ）,and to provide a theoretical basis for future clinical trials.Methods The Wanfang,CNKI,VIP,PubMed/MEDLINE,EMBASE database （from January 1979 to September 2012） were searched.All papers concerning TCM in animal model of lung injury induced by PQ were retrieved.Study selection and data extraction were performed on the basis of Cochrane systematic review methods.Weighted mean difference （WMD） and 95％ confidence interval （95％CI） with random effects model was adopted to investigate the effect of TCM on lung injury induced by PQ.Results Eighteen papers involving 1 188 rats met our criteria.Meta-analysis showed that TCM could improve the lung coefficiency （WMD-0.07,95％ CI-0.14 to-0.01,P=0.03）,reduce lung wet/dry weight ratio （WMD-1.15,95％CI-2.03 to-0.27,P=0.01）,increase the serum superoxide dismutase （SOD） activity （WMD 56.08,95％CI 23.46 to 88.70,P=0.000 8）,improve plasma glutathione peroxidase （GSH-Px） level （WMD 26.64,95％CI 18.95 to 34.33,P＜0.000 01）,and lower serum malondialdehyde（MDA） level （WMD-0.65,95％CI-1.00 to-0.30,P=0.000 2）,however there was no significant difference in the level of serum tumor necrosis factor-α （TNF-α） and hydroxyproline （HYP） level between TCM and controls （TNF-α：WMD-25.15,95％CI-54.87 to 4.57,P=0.10; HYP：WMD-0.11,95％CI-2.71 to 0.48,P=0.17）.Conclusions These findings demonstrate the efficacy of TCM in animal models of lung injury induced by PQ.However taking account of heterogeneity,the efficacy should be interpreted with caution.