中西医结合治疗小儿咳嗽变异性哮喘的Meta分析

Meta-analysis of Traditional Chinese Medicine and Western Medicine in Treating Cough Variant Asthma in Children

目的:系统评价中西医结合治疗小儿咳嗽变异性哮喘(cough variant asthma,CVA)的有效性和安全性。方法:计算机检索The Cochrane Library,Pubmed,Embase,中国期刊全文数据库(CNKI),中国生物医学文献数据库(CBM),中国科技期刊全文数据库(VIP)和万方数据库等,检索时间限定为建库至2015年6月8日,检索所有中西医结合治疗小儿咳嗽变异性哮喘的随机对照试验(randomized controll trials,RCTs),并追索纳入研究的参考文献。由两位评价者独立对纳入研究的质量进行严格评价和资料提取后,采用Rev Man 5.3软件进行Meta分析。结果:最终纳入33个研究,共3 106例患儿。Meta分析结果显示:与单纯西医治疗相比,中西医结合治疗能显著提高咳嗽变异性哮喘患儿的有效率[OR=4.68,95%CI(13.68,5.95),P<0.000 01],缩短咳嗽消失时间[MD=-4.39,95%CI(-6.25,-2.54),P<0.000 01],改善FEV1%值[OR=8.53,95%CI(2.19,14.86),P=0.008],改善PEF%值[MD=7.01,95%CI(6.07,7.95),P<0.000 01],降低复发率[OR=0.34,95%CI(0.25,0.45),P<0.000 01],其差异均具有统计学意义。结论:中西医结合治疗小儿咳嗽变异性哮喘能显著提高临床疗效,缩短咳嗽消失时间,改善肺功能指标[一秒用力呼气容积(FEV1%),呼气峰流速占正常预计值的百分比(PEF%)],降低复发率。但鉴于本系统评价纳入的所有研究方法学和报告质量均不高,且样本量较少,故中西医结合治疗小儿咳嗽变异性哮喘的疗效以及安全性仍需要严格的、大样本的随机对照试验加以验证。

Objective： To systematically evalate the safety and efficacy of the combination of traditional Chinese medicine and western medicine in treating cough variant asthma in children. Method： We searched The Cochrane Library,Pubmed,Embase,CNKI,CBM,VIP and Wanfang Data from databasethrough computer for data as at June 8,2015. All of randomized controlled trials（ RCTs） of the combination of traditional Chinese medicine and western medicine on in treating cough variant asthma in children were searched,and research literatures included in the RCTs were also traced. Two researchers independently conducted the strict quality evaluation and data extraction for the included studies and made a Meta-analysis by using Rev Man 5. 3 software.Result： Totally 33 RCTs involving 3 106 patients were included into the study. The Meta-analysis results showed that compared with western medicine,the combination of traditional Chinese medicine and western medicine can significantly improve the clinical effective rate [OR = 4. 68,95% CI（ 13. 68,5. 95）,P 〈 0. 000 01 ],reduce recurrence rate [OR = 0. 34,95% CI（ 0. 25,0. 45）,P 〈 0. 000 01 ],improve forced expiratory volume in one second（ FEV1%） [OR = 8. 53,95% CI（ 2. 19,14. 86）,P = 0. 008 ],increase peak expiratory flow（ PEF%）[MD = 7. 01,95% CI（ 6. 07,7. 95）,P 〈 0. 000 01],shorten coughing time [MD =-4. 39,95% CI（-6. 25,-2. 54）,P 〈 0. 000 01],with statistically significant difference in both groups. Conclusion： The combination of traditional Chinese medicine and western medicine in treating cough variant asthma in children can effectively improve the clinical effective rate,reduce recurrence rate,improve lung function indexes（ FEV1%,PEF%） and,shorten coughing time. However,due to the low methodology and quality and small sample size of included RCTs in this study,more RCTs with a large sample size are required to further verify the efficacy and safety of the combination of traditional Chinese medicine and western medicine in treating cough variant asthma in children.