玉屏风颗粒联合西药治疗儿童反复呼吸道感染系统评价

Systematic Evaluation on Yupingfeng Granules Combined with Western Medicine in the Treatment of Children with Recurrent Respiratory Tract Infections

目的系统评价玉屏风颗粒联合西药治疗儿童反复呼吸道感染(RRTI)的临床疗效和安全性。方法计算机检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)、中国生物医学文献服务系统(Sino Med)、Pub Med、Embase、Cochrane Library中玉屏风颗粒联合西药治疗儿童RRTI临床随机对照试验相关文献,检索时间范围均为建库至2015年10月。2名研究者按照Cochrane偏倚风险评价标准独立筛选文献、提取数据、交叉核对及质量评价后,采用Rev Man5.3软件进行Meta分析。结果共纳入8篇文献,受试者550例。Meta分析结果显示:玉屏风颗粒联合西药治疗儿童RRTI有效率[OR=4.16,95%CI(2.49,6.95),P<0.000 01]、Ig A水平[MD=0.52,95%CI(0.26,0.78),P<0.000 1]、IgG水平[MD=2.75,95%CI(1.25,4.25),P=0.000 3]、CD4^+水平[MD=6.15,95%CI(4.76,7.54),P<0.000 01]、CD4^+/CD8^+水平[MD=0.36,95%CI(0.25,0.47),P<0.000 01]均优于单纯西药治疗,IgM、CD8^+水平差异无统计学意义(P>0.05)。结论玉屏风颗粒联合西药治疗儿童RRTI在提升有效率、抗体水平和T细胞水平方面具有明显优势,总体疗效优于单纯西药治疗,但尚需更多大样本、多中心、高质量的临床随机对照试验进一步验证。

Objective To evaluate clinical efficacy of Yupingfeng Granules combined with western medicine for children with recurrent respiratory tract infection（RRTI）. Methods CNKI, VIP, WANFANG DATA, Sino Med, Pub Med, Embase, and Cochrane Library were searched for the randomized controlled trials（RCTs） that investigated the clinical and immune effects of Yupingfeng Granules in children with RRTI from inception to October 2015. Two researchers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of included studies. Then Meta analysis was performed through the software Rev Man 5.3. Results A total of 8 articles involving 550 patients were included. The results of Meta analysis showed effective rate of Yupingfeng Granules combined with western medicine for children with RRTI [OR=4.16, 95%CI（2.49, 6.95）, P〈0.000 01], Ig A level [MD=0.52, 95%CI（0.26, 0.78）, P〈0.000 1], Ig G level [MD=2.75, 95%CI（1.25, 4.25）, P=0.000 3], CD4^＋ level [MD=6.15, 95%CI（4.76, 7.54）, P〈0.000 01], CD4^＋/CD8^＋ level [MD=0.36, 95%CI（0.25, 0.47）, P〈0.000 01]. All of the above were superior to single western medicine treatment. There was no statistical significance in levels of Ig M and CD8^＋（P〈0.05）. Conclusion Yupingfeng Granules combined with western medicine can improve effective rate, antibody level and T-cell level in the treatment of children with RRTI. The overall clinical efficacy is better than single western medicine treatment. However, RCTs with large samples, multiple centers and high quality are needed for further verification.