宣白承气汤单独用药及联合用药治疗肺炎痰热壅肺证Meta分析

Single administration of Xuanbai Chengqi decoction and combined administration for pneumonia with syndrome of phlegm-heat obstructing lung:a Meta-analysis of randomized clinical trials

目的:系统评价宣白承气汤单用及联合用药治疗肺炎痰热壅肺证的临床疗效。方法:检索CNKI、万方、CBM、PubMed等数据库,筛选宣白承气汤治疗肺炎的随机对照试验(RCT),运用Cochrane协作网偏倚风险评价工具进行文献质量评价,使用Revman 5.3软件进行Meta分析。结果:最终纳入16项研究,共1393例患者,纳入文献质量不高。Meta分析结果表明,与单纯西医治疗相比,使用宣白承气汤可明显提高肺炎痰热壅肺证的临床总有效率[RR=1.29,95%,CI(1.22,1.36),P<0.00001],且亚组分析显示单用或联用宣白承气汤的组间差异无统计学意义;可明显改善APACHE II评分、CPIS评分,明显降低炎症因子水平,改善中医证候积分。结论:宣白承气汤可有效治疗肺炎痰热壅肺证,但鉴于纳入临床研究在质量上存在一定局限性,得出的阳性结果仅作为临床诊疗的提示与参考,急需开展更多的高质量大规模的RCT来进一步验证。

Objective:To systematically evaluate the efficacy of single administration of Xuanbai Chengqi decoction and combined administration in treatment of pneumonia with syndrome of phlegm-heat obstructing lung.Methods:CNKI、Wanfang、CBM、PubMed were searched for randomized controlled trials of Xuanbai Chengqi decoction in treatment of pneumonia.Cochrane collaboration network was used to evaluate the quality of included studies and RevMan 5.3 to Meta-analysis.Results:A total of 16 studies involving 1393 patients were eventually included and the quality of these literature was generally low.Meta-analysis results showed that compared with western routine treatment,Xuanbai Chengqi decoction can significantly improve total clinic efficacy of pneumonia(phlegm-heat obstructing lung syndrome)[RR=1.29,95%,CI(1.22,1.36),P<0.00001],as well as the subgroup analysis showed there have little difference about the efficacy between single administration and combined administration of it;decrease APACHE II scores、CPIS score;reduce the levels of inflammatory factors and make TCM syndrome score lower.Conclusion:Xuanbai Chengqi decoction can effectively treat pneumonia(obstruction of phlegm and heat with lung obstruction),however,due to some limitations in the quality of the included clinical studies,the positive results obtained are only used as a hint and reference for clinical diagnosis and treatment.Therefore,it is urgent to carry out more high-quality large-scale RCT to further verify.