中医外治法辅助治疗支原体肺炎有效性的网状Meta分析

Network meta-analysis of effectiveness of TCM external treatment in treatment of mycoplasmal pneumonia

目的:采用网状Meta分析的方法,比较不同中医外治法联合阿奇霉素治疗肺炎支原体肺炎(MPP)的有效性和安全性。方法:主题词与自由词结合检索CNKI、VIP、CBM、Wan Fang Date、PubMed、Sciencedirect及谷歌学术数据库中关于中医外治法联合阿奇霉素治疗MPP患儿影响的临床随机或半随机对照试验的文献,检索时限为建库起到2019年8月。由2名评价员根据纳入及排除标准,独立进行筛选文献、提取资料及文献质量评价后,采用ADDIS软件、RevMan5.3和stata14.0软件进行网状Meta分析。结果:共纳入18篇随机对照文献,涉及MPP患儿1 536例,6种中医外治法(超短波、穴位贴敷、拔罐、灌肠、中药贴片、推拿),网状Meta分析的结果表明,在治疗MPP有效率方面,超短波、穴位贴敷、拔罐、灌肠、中药贴片、推拿联合阿奇霉素治疗方案比单用阿奇霉素有效,概率分布显示中药贴片联合阿奇霉素治疗方案成为最佳方案的概率最大(P=0.34)。在减少不良反应方面由于超短波和中药贴片文献中未提及不良率,本研究只分析了其余四种外治法的不良,穴位贴敷、拔罐、灌肠、推拿联合阿奇霉素方案优于单用阿奇霉素,概率分布显示推拿联合阿奇霉素方案成为最佳方案的概率最大(P=0.67)。结论:在有效率、不良反应减少方面,各种中医外治法联阿奇霉素治疗MPP对比单用阿奇霉素具有优势。概率分布显示,在治疗MPP的有效率方面,中药贴片+阿奇>超短波+阿奇>灌肠+阿奇>拔罐+阿奇>刮痧+阿奇>推拿+阿奇,中药贴片+阿奇霉素方案为最优方案;在减少不良反应方面,推拿+阿奇>灌肠+阿奇>穴位贴敷+阿奇>阿奇霉素>拔罐+阿奇。

Objective: To compare the efficacy and safety of different traditional Chinese medicine(TCM) external treatment methods combined with azithromycin in the treatment of Mycoplasma pneumoniae pneumonia(MPP). Methods: The keywords and free words were combined to search the literatures of clinical randomized or quasi-randomized controlled trials on the effects of TCM external treatment methods combined with azithromycin in the treatment of children with MPP in CNKI, VIP, CBM, Wan Fang Date, PubMed, Sciencedirect and Google Academic Database. The retrieval time limit was from the establishment of databases to August 2019. After two independent reviewers selected the literature, extracted data and evaluated literature quality according to the inclusion and exclusion criteria, the ADDI software, RevMan5.3 and stata14.0 software were used for mesh meta-analysis. Results: A total of 18 randomized controlled literatures were included, involving 1 536 children with MPP, and 6 Chinese medicine external treatment methods(ultra-short wave, acupoint application, cupping, enema, Chinese medicine patch, and massage). The results of network meta-analysis showed that in terms of efficiency in the treatment of MPP, ultrashort wave, acupoint application, cupping, enema, Chinese medicine patch, or massage combined with azithromycin treatment was more effective than azithromycin alone, and the probability distribution showed that the Chinese medicine patch combined with azithromycin treatment was the best solution(P=0.34). In the reduction of adverse reactions, since the ultrashort wave and traditional Chinese medicine patch literature did not mention the non-performing rate, this study only analyzed the other four external treatment methods. Acupoint application, cupping, enema, or massage combined with azithromycin was better than azithromycin alone. The probability distribution showed that the probability of massage combined with azithromycin was the best(P=0.67). Conclusion: In terms of efficiency and reduction of adverse reactions, each Chinese medicine external treatment combined with azithromycin has an advantage over single azithromycin. Probability distribution shows that in the effectiveness of treatment of MPP, Chinese medicine patch + azithromycin > ultrashort wave + azithromycin > enema + azithromycin > cupping + azithromycin > massage + azithromycin. Chinese medicine patch + azithromycin program is the optimal program. In terms of reducing adverse reactions, massage + azithromycin > enema + azithromycin > acupressure application + azithromycin > cupping + azithromycin.