温阳化饮法治疗慢性阻塞性肺疾病的系统分析

Systematic Analysis on the Treatment of Chronic Obstructive Pulmonary Disease with Wenyanghuayin Method

目的通过计算机检索中国知网、PubMed等7个中英文数据库,检索时限为建库至2019年7月检索温阳化饮法治疗慢性阻塞性肺疾病(COPD)的临床随机对照试验(RCT)。方法分别需要2位研究者,依据纳排标准独立筛查文献、提取相关数据等资料,然后用偏倚风险评价工具Cochrane,对随机对照试验评价文献质量,运用RevMan5.3软件行Meta分析,系统评价温阳化饮法治疗COPD的临床疗效、肺功能指标、血气分析指标及炎症因子改善情况。共纳入13篇RCT,包括1154例患者。结果Meta分析结果显示:与对照组比较,温阳化饮组临床有效率更高[RR=1.34,95%CI(1.02,1.49),P<0.00001];肺功能改善明显,包括第1秒呼气量(FEV1)[MD=0.3,95%CI(0.14,0.47),P<0.00001]、第1秒呼吸容积占用力肺活量百分比(FEV1/FVC)[MD=2.94,95%CI(1.51,4.36),P<0.0001]和呼气高峰流量(PEFR)[MD=1.38,95%CI(1.10,1.65),P<0.0001];并且降低炎症因子水平,包括肿瘤坏死因子-α(TNF-α)[MD=-0.50,95%CI(-0.63,-0.37),P<0.00001]和白细胞介素-8(IL-8)[MD=-2.02,95%CI(-3.10,-0.95),P=0.0002];同时能改善血气分析指标水平,包括降低PCO2[MD=-0.48,95%CI(-0.74,-0.23),P=0.0002]和提高PO2[MD=2.23,95%CI(1.28,3.19),P<0.00001];同时统计临床资料中使用频次居前6位的中药,依次是麻黄、干姜、附子、细辛、黄芪、杏仁。结论目前证据表明临床治疗COPD时,应注重中医温阳化饮法的使用,同时重视麻黄、干姜、附子、细辛等中药的灵活合理应用。而且,温阳化饮组的不良反应发生率低。研究提示,在西医常规基础治疗基础上加温阳化饮中药治疗COPD,可提高临床疗效,改善肺功能,有助于减少炎症发生,调节血气指标,但因纳入研究数量及质量的限制,尚缺少高质量证据证实温阳化饮法的临床疗效,因此需更多设计严谨、大样本的多中心随机对照试验加以验证。

Objective:seven Chinese and English databases such as CNKI and PubMed were searched by computer,and the retrieval time limit was from the establishment of the database to July 2019 to the collection of relevant wenyanghuayin treatment of chronic diseases. A randomized controlled clinical trial(RCT)for obstructive pulmonary disease(COPD). Methods:Two researchers were respectively required to independently screen literature and extract relevant data according to the criteria of inclusion and exclusion,and then used the bias risk assessment tool Cochrane to evaluate the quality of literature in randomized controlled trials,and used Revman 5.3 software for meta analysis to systematically evaluate the clinical efficacy,lung function,blood gas and inflammatory factor improvement of Wenyang Huayin in the treatment of chronic obstructive pulmonary disease. A total of 13 RCTs were included,including 1 154 patients. Results:Meta analysis showed that:compared with the control group,the clinical effective rate of wenyanghuayin group was higher(RR=1.34,95%CI(1.02,1.49),P < 0.00001);the improvement of pulmonary function was significant,including the first second expiratory volume(FEV1)[MD=0.3,95%CI(0.14,0.47),P < 0.00001],the first second respiratory volume as a percentage of forced vital capacity(FEV1/FVC)[MD=2.94,95%CI(1.51,4.36),P < 0.0001],and the high expiratory volume. Peak flow rate(PEFR)[MD=1.38,95%CI(1.10,1.65),P < 0.0001];and decreased inflammatory factor levels,including tumor necrosis factor-α(TNF-α)[MD=-0.50,95%CI(-0.63,-0.37),P < 0.00001]and interleukin-8(IL-8)[MD=-2.02,95%CI(-3.10,-0.95),P = 0.0002];at the same time,it can improve blood gas level,including reducing arterial carbon dioxide partial pressure(PaCO2 a[MD=-0.48,95%CI(-0.74,-0.23),P = 0.0002]and increase PaO2[MD=2.23,95%CI(1.28,3.19),P < 0.00001]. Meanwhile,the top 6 Chinese herbs used in clinical data were ephedra,ginger,aconite,asarum,Astragalus and almond. Conclusion:At present,the evidence shows that in the clinical treatment of COPD,we should pay attention to the use of wenyanghuayin,and pay attention to the flexible and reasonable application of ephedra,ginger,aconite,asarum and other traditional Chinese medicines. Moreover,the incidence of adverse reactions in wenyanghuayin group was low. It is suggested that the treatment of chronic obstructive pulmonary disease with traditional western medicine plus wenyanghuayin can improve the clinical effect,improve the pulmonary function,reduce the incidence of inflammation and regulate the blood gas index. However,due to the limitation of the quantity and quality of the study,there is no high-quality evidence to prove the clinical effect of wenyanghuayin,so more rigorous and large sample design is needed. A multicenter randomized controlled trial was conducted to verify the results。