中医外治法联合中药治疗感染后咳嗽的系统评价与Meta分析

Systematic Evaluation and Meta Analysis on the Efficacy of TCM External Treatment Combined with Chinese Medicinal in the Treatment of Post-Infectious Cough

目的:采用系统评价和Meta分析方法比较中医外治法治疗该病的临床疗效。方法:计算机检索包括CNKI、Wan Fang Data、CBM和VIP中文数据库;Embase、PubMed和Cochrane Library外文数据库。检索起止日期为建库时间—2018年11月30日。搜集中医外治法治疗PIC的随机对照试验(RCT),采用NoteExpress软件初步筛选文献,随之按纳入、排除标准严格筛选出最后符合文献,并按改良Jadad评分量表、偏倚风险评估工具对文献进行质量评价,RevMan5.3软件整合分析。结果:符合纳入标准的14篇RCT文献,其中只有1篇为高质量文献,共1 167例患者。结果显示,总有效率的RR=1.15,95%CI[1.10,1.20],Z=5.93,P<0.000 01;LCQ积分的WMD=3.75,95%CI[-0.26,7.76],Z=1.83,P>0.05;咳嗽的WMD=-0.54,95%CI[-0.87,-0.21],Z=3.2,P<0.05;咳痰的WMD=-0.68,95%CI[-0.97,-0.39],Z=4.63,P<0.000 01;咽痒的WMD=-0.32,95%CI[-0.60,-0.04],Z=2.21,P<0.05;中医症候总积分WMD=-0.91,95%CI[-1.19,-0.64],Z=6.51,P<0.000 01;咳嗽VAS积分的WMD=-0.96,95%CI[-1.65,-0.26],Z=2.7,P<0.05;诱导痰上清液中P物质浓度积分的WMD=-39.48,95%CI[-40.68,-32.28],Z=64.59,P<0.000 01;复发率的RR=0.67,95%CI[0.18,2.47],Z=0.61,P>0.05;咳嗽缓解时间的RR=-1.82,95%CI[-2.57,-1.08],Z=4.81,P<0.000 01;咳嗽消失时间的WMD=-2.48,95%CI[-3.99,-0.98],Z=3.23,P<0.05;不良反应的RR=0.50,95%CI[0.18,1.42],Z=1.30,P>0.05。结论:中医外治法联合中药治疗感染后咳嗽的临床疗效确切,但纳入RCT文献的方法学质量偏低,样本量偏少,无法提供有力的循证医学依据,仍需要更多大样本、多中心、高质量的RCT进一步佐证。

Objective:To compare the clinical efficacy of TCM external treatment combined with Chinese medicinal in the treatment of post-infectious cough(PIC)by systematic evaluation and Meta analysis.Methods:Data were retrieved from databases of CNKI,Wan Fang Data,CBM,VIP,Embase,PubMed,and Cochrane Library.The retrieval started from the date of database construction to November 30,2018.RCTs of PIC treated with TCM external treatment were collected,NoteExpress software was used to screen the literatures according to the inclusion and exclusion criteria,and were evaluated according to the modified Jadad scoring scale and bias risk assessment tool.RevMan5.3 software was used for integrated analysis.Results:Fourteen eligible RCT articles were included,of which only one was of high quality,with a total of 1 167 patients.The results showed that in terms of the total effective rate,RR=1.15,95%CI[1.10,1.20],Z=5.93,P<0.000 01;in terms of LCQ integral,WMD=3.75,95%CI[-0.26,7.76],Z=1.83,P>0.05;in terms of cough,WMD=-0.54,95%CI[-0.87,-0.21],Z=3.2,P<0.05;in terms of expectoration,WMD=-0.68,95%CI[-0.97,-0.39],Z=4.63,P<0.000 01;in terms of pharyngeal itching,WMD=-0.32,95%CI[-0.60,-0.04],Z=2.21,P<0.05;in terms of TCM syndrome total score,WMD=-0.91,95%CI[-1.19,-0.64],Z=6.51,P<0.000 01;in terms of the scores of cough VAS,WMD=-0.96,95%CI[-1.65,-0.26],Z=2.7,P<0.05;in terms of the concentration integral of substance P in induced sputum supernatant,WMD=-39.48,95%CI[-40.68,-32.28],Z=64.59,P<0.000 01;in terms of the recurrence rate,RR=0.67,95%CI[0.18,2.47],Z=0.61,P>0.05;in terms of cough relieve time,RR=-1.82,95%CI[-2.57,-1.08],Z=4.81,P<0.000 01;in terms of cough disappearance time,WMD=-2.48,95%CI[-3.99,-0.98],Z=3.23,P<0.05;in terms of adverse reactions,RR=0.50,95%CI[0.18,1.42],Z=1.30,P>0.05.Conclusion:The clinical efficacy of TCM external treatment combined with Chinese medicinal is effective in the treatment of post-infectious cough,but the methodological quality of the included literatures is low and the sample size is small,which cannot provide a strong evidence-based medical basis.More large samples,multi-center and high-quality RCTs are still needed for further evidence.