痰热清注射液联合阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎的疗效与安全性的Meta分析

A Meta-analysis on Efficacy and Safety of combination of Tanreqing injection with zithromycin used by sequential therapy in treating Children Mycoplasma Pneumoniae Pneumonia

目的:系统评价痰热清注射液联合阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎的有效性与安全性。方法:计算机检索中国医院知识总库(CHKD)期刊全文数据库(建库至2013年5月)、万方医药中文数据库、中文科技期刊全文数据库(VIP)、Pubmed数据库、Sciencedirect数据库及Google scholor中关于痰热清注射液联合阿奇霉素序贯疗法治疗小儿支原体肺炎的随机对照试验。对文献进行质量评价,应用Revman 5.0软件进行Meta分析。结果:共纳入28项试验,共2917例患者,Meta分析结果提示痰热清联合阿奇霉素序贯疗法治疗小儿支气管肺炎的总有效率优于单独使用阿奇霉素序贯疗法[OR=5.57,95%CI=(4.00,7.77),P<0.001];能明显缩短咳嗽、发热、肺部啰音消失时间及胸片阴影吸收时间,促进血清CRP的降低;减少不良反应的发生率[OR=0.40,95%CI=(0.29,0.54),P<0.001],尤其是胃肠道反应,但对皮疹和局部疼痛或静脉炎等不良反应无明显影响。结论:痰热清联合阿奇霉素序贯疗法可有效缓解小儿支原体肺炎的总体症状,促进咳嗽、发热、肺部啰音、胸片炎症阴影的改善,减少不良反应的发生。但受纳入研究质量的限制,以上结论尚需更多大规模、高质量的临床对照试验予以证实。

Objective： To compare the efficacy and safety of combination of Tanreqing inject with Azithromycin used by sequential therapy in treating Children Mycoplasma Pneumoniae Pneumonia（MPP）. Methods： CHKD（from its inception to May 2013）, Wanfang（from 1998 to May 2013）,VIP（from 1989 to May 2013）,Pubmed, Sciencedirect databases and Google scholor were seached for randomized controlled trials（RCTs） on Tanreqing with sequential therapy of Azithromycin for the treatment of Children MPP. The methodological quality of the included studies was assessed and the Meta-analysis was performed with Revman 5.0. Results： A total of 28 RCTs involving 2917 patients were included. The total effective rate [0R=5.57, 95%CI=（4.00, 7.77）,P〈0.001] of Tanreqing with sequential therapy of Azithromycin treatment group were superior to that of the treatment without Tanreqing group; It could help shorten the extinction time of cough, fever, moist and dry rales and the shodow in X-ray, and decrease the concentration of CRP. The incidence of adverse drug reactions（ADRs） was decreased [OR=0.40,95%CI=（0.29,0.54）,P〈0.001] such as Gastrointestinal ADRs. But there was no significant difference of two grot, ps in erythra and phlebitis. Conclusion： Combination of Tanreqing and Azithromycin used in sequential therapy is effective for the treatment of children MPP especially in cough, fever, moist and dry rales and the shadow in X-ray and decreases incidence ADRs especially in gastrointestinal disconffort. However, due to the quality of included studies, more large-scale and high quality RCTs are expected to verify the conclusion in future