喜炎平注射液治疗成人病毒性肺炎的系统评价和Meta分析

System evaluation and meta analysis of Xiyanping injection in the treatment of adult viral pneumonia

目的系统评价喜炎平注射液治疗成人病毒性肺炎的有效性及安全性。方法采用Cochrane系统评价方法,电子检索中国知网数据库(CNKI)、万方数据库(WANFANG)、重庆维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CMB)、PubMed从建库到2017年3月所发表的相关文献。筛选文献、提取资料,采用Cochrane协作网推荐的"偏倚风险评估"工具评估纳入研究的质量,使用RevMan5.3软件对纳入的研究进行Meta分析,并用GRADE评级系统进行证据评级。结果最终纳入5个随机对照试验(RCT),共461例患者。3个研究报告了临床痊愈率指标,提示对比利巴韦林组,喜炎平组能提高痊愈率(RR=1.67[1.18,2.37])。2个研究报告了发热、咳嗽、肺部啰音的消失时间,提示对比利巴韦林组,喜炎平组能缩短咳嗽消失时间[MD=-1.95(-2.42,-1.48)]及肺部啰音消失时间[MD=-1.99(-2.90,-1.08)]。在退热时间上,喜炎平组与利巴韦林组无统计学差异[MD=-1.62(-3.48,0.23)]。4个研究报告了不良反应的发生情况,主要为胃肠道刺激症状,对比利巴韦林组,喜炎平组能降低不良反应发生率。结论现有证据表明,喜炎平注射液治疗成人病毒性肺炎的临床疗效优于利巴韦林注射液,能提高痊愈率,改善症状体征,降低不良反应发生率。但受纳入研究数量及质量限制,证据尚不充分,期待有更多高质量、多中心、大样本的随机双盲对照试验以进一步验证其疗效。

Objective To systematic review the efficacy and safety of Xiyanping injection on adult viral pneumonia. Methods Literature retrieval was implemented with CNKI, WanFang Database, VIP and SinoMed electronically from inception to March 2017. The quality of included studies was evaluated according to the criteria recommended by the Cochrane Handbook, and the meta-analysis was performed by RevMan 5. 3 software. Results Five RCTs（461 patients） were adopted on the basis of our search criteria. Three of them reported the clinical recovery rate, meta-analysis revealed that, comparing to Ribavirin, Xiyanping injection could improve the recovery rate on the treatment of adult viral pneumonia. Two trials reported the disappearing time of fever, cough and pulmonary rale, in which the experimental group showed comparative advantages, except the disappearing time of fever that had no statistic difference.Four studies reported adverse reaction, mainly manifested as gastrointestinal irritation. And the incidence rate of adverse reaction was lower in experimental group. Conclusion Current evidence indicates Xiyanping injection has an advantage in efficacy and safety compared with Ribavirin. However, restricted by the quantity and quality of studies, the evidence was insufficiency. Consequently, large scale, multi-center, randomized and double-blinded controlled trials are necessary for further confirmation.