肺肠同治法治疗慢性阻塞性肺疾病急性加重期临床随机试验的Meta分析

Meta-analysis of Randomized Clinical Trials of Pulmonary-intestinal Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的系统评价肺肠同治法治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效。方法计算机检索PubMed、Embase、The Cochrane Library、中国生物医学文献服务系统(CBM)、中国知网(CNKI)、维普网(VIP)和万方数据等数据库,纳入研究肺肠同治法治疗AECOPD疗效的随机对照试验,检索时限均为建库至2018年7月,由2位评价者按照纳入与排除标准独立筛选文献、提取资料,采用Cochrane的偏倚风险表评估研究质量,使用RevMan5.3软件进行Meta分析。结果最终纳入15个随机对照试验,共1 105例病例。试验组与对照组比较,试验组可提高临床疗效[OR=0.21,95%CI(0.14,0.30),P <0.00001],并在改善肺功能及血气分析方面具有一定优势。结论肺肠同治法治疗AECOPD较单纯西医治疗更有优势,且具有统计学意义,但因纳入研究的方法学、报告质量较低,仍需大样本、正确的随机方法和分配隐藏设计的临床研究,才能得到更加真实可靠的结果。

Objective:To systematically evaluate the efficacy of pulmonary-intestinal therapy on acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods:Computer was used to search for pulmonaryintestinal therapy on AECOPD in PubMed,Embase,the Cochrane Library,CBM,CNKI,VIP and Wan Fang Data,etc. The retrieval time was from the establishment of the database to July 2018. Two evaluators independently screened literature and extracted data according to inclusion and exclusion criteria. Cochrane′s bias risk table was used to evaluate the quality of the research,and RevMan 5.3 software was used for meta-analysis. Results:15 randomized controlled trials were included,1 105 cases involved. Compared with the control group,the experimental group could significantly improve the clinical efficacy[OR=0.21,95%CI(0.14,0.30),P < 0.00001],and had certain advantages in improving lung function and blood gas analysis. Conclusion:The pulmonary-intestinal therapy on AECOPD is more advantageous than that with Western medicine alone. However,due to the low quality of the methodology and reports included in the study,it still needs large samples,correct random methods and clinical studies with hidden design to obtain more reliable results.