中西医结合治疗新型冠状病毒肺炎的系统评价

Clinical effects of integrated treatnent of traditional Chinese and western medicine on COVID-19: a systematic review

目的系统评价中西医结合治疗新型冠状病毒肺炎(简称"新冠肺炎")的临床疗效。方法计算机检索万方(WANFANG DATA)、中国知网(CNKI)、MEDLINE、Embase数据库,检索时间为自建库开始至2020年3月12日。根据Cochrane手册"偏倚风险"评估工具独立评估偏倚风险;采用纽卡斯尔-渥太华量表(NOS)进行非随机试验方法学质量评估,通过证据质量分级(GRADE)来衡量证据的质量;运用Review Manager 5.3软件对不同干预措施治疗新冠肺炎的结局指标进行Meta分析,比较治疗组(中西医结合治疗)与对照组(西医常规治疗)的临床疗效。结果①共纳入8个临床研究,包括804例病例。②其中1项研究为随机对照试验,4项研究为回顾性队列研究,另有自身前后对照研究1项、病例系列研究2项;5项研究纳入Meta分析,3项无对照组的研究仅出现在NOS评估中。③2项研究对重症转化率作了比较分析,结果提示治疗组的重症转化率低于对照组[RR=0.18,95%CI(0.04,0.79),P=0.02]。④3项研究对临床治愈率作了比较分析,结果提示治疗组临床治愈率高于对照组[OR=7.82,95%CI(2.04,30.06),P=0.003]。⑤2项研究对病死率作了分析,结果显示两组差异无统计学意义[RR=0.18,95%CI(0.01,4.23),P=0.29],无法得出异质性结论。⑥4项研究对发热时间作了比较分析,研究间存在明显异质性(Q统计量相应P值为0.003,I^2=84%),结果提示治疗组退热疗效优于对照组[MD=-0.81,95%CI(-1.53,-0.09),P=0.03],但需进一步分析其异质性的来源。⑦2项研究对症状积分作了比较分析,结果提示治疗组较对照组能更好地改善患者的临床症状[SMD=-0.84,95%CI(-1.25,-0.43),P<0.0001]。⑧3项研究对咳嗽缓解率作了比较分析,结果提示治疗组较对照组能更好地改善患者的咳嗽症状[OR=5.14,95%CI(1.49,17.75),P=0.010]。⑨3项研究对腹泻缓解率作了比较分析,结果显示两组差异无统计学意义[OR=1.19,95%CI(0.17,8.64),P=0.86]。⑩3项研究对肺炎吸收率作了比较分析,结果显示两组差异无统计学意义[RR=1.02,95%CI(0.85,1.22),P=0.87]。结论中西医结合治疗可降低新冠肺炎患者的重症转化率,提高临床治愈率,还在缓解咳嗽、退热等方面存在一定的优势。后续需要更多高质量的临床循证研究不断更新,才能完善本研究的证据完整性。

Objectives To systematically evaluate the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of coronavirus disease 2019(hereinafter referred to as"COVID-19").Methods Data were collected by searching Wanfang DATA,CNKI,MEDLINE and Embase databases from the creation date of these databases to March 12,2020.The risk of bias was assessed according to the Cochrane Manual"Risk of Bias"assessment tool.Newcastle-Ottawa Scale(NOS)was used to evaluate the methodological quality of non-random trials,and the quality of evidence was measured by GRADE.Review Manager 5.3 software was used for meta-analysis on the outcome indexes of different intervention measures in the treatment of COVID-19,and comparison of the clinical effects between the treatment group(integrated treatment of traditional Chinese and western medicine)and the control group(conventional western medicine treatment).Results①A total of 8 clinical studies were included,containing 804 cases.②One of the studies was a randomized controlled trial,four were retrospective cohort studies,one was before-after study in the same patient,and two were case series studies.Five studies were included in meta-analysis,and three studies without control group were only evaluated by NOS.③The conversion rate of severe cases was compared and analyzed in two studies.The results showed that the conversion rate of severe cases in the treatment group was lower than that in the control group[RR=0.18,95%CI(0.04,0.79),P=0.02].④The clinical cure rate was compared and analyzed in three studies.The results showed that the clinical cure rate of the treatment group was higher than that of the control group[OR=7.82,95%CI(2.04,30.06),P=0.003].⑤The mortality rate was analyzed in two studies.The results showed that there was no significant difference between the two groups[RR=0.18,95%CI(0.01,4.23),P=0.29],and no heterogeneity conclusion could be drawn.⑥The fever duration was compared and analyzed in four studies,and there were obvious heterogeneity among the studies(P=0.003,I2=84%).The results suggested that the antipyretic effect of the treatment group was better than that of the control group[MD=-0.81,95%CI(-1.53,-0.09),P=0.03],but the further analysis on the sources of heterogeneity was required.⑦The symptom scores were compared and analyzed in two studies.The results showed that the clinical symptoms of the patients were better improved in the treatment group than in the control group[SMD=-0.84,95%CI(-1.25,-0.43),P<0.0001].⑧The remission rate of cough was compared and analyzed in three studies.The results showed that the cough symptom was better relieved in the treatment group than in the control group[OR=5.14,95%CI(1.49,17.75),P=0.010].⑨The remission rate of diarrhea was compared and analyzed in three studies.The results showed that there was no significant difference between the two groups[OR=1.19,95%CI(0.17,8.64),P=0.86].⑩The absorption rate of pneumonia was compared and analyzed in three studies.The results showed that there was no significant difference between the two groups[RR=1.02,95%CI(0.85,1.22),P=0.87].Conclusion The integrated treatment of traditional Chinese and western medicine can reduce the conversion rate of severe cases,improve the clinical cure rate,and has certain advantages in relieving cough and fever among patients with COVID-19.In order to improve the evidence integrity of this study,more high-quality clinical evidence-based studies are needed for data update.