《新型冠状病毒肺炎诊疗方案》推荐的清热解毒中药注射液治疗病毒性肺炎疗效评价的网状Meta分析

Net Meta-analysis of Efficacy Evaluation of Clearing Heat and Detoxification TCM Injections Recommended by COVID-19 in Treatment of Viral Pneumonia

目的运用网状Meta分析(Network Meta-Analysis,NMA)的方法比较喜炎平注射液、热毒宁注射液、痰热清注射液治疗病毒性肺炎的临床疗效。方法检索3种清热解毒中药注射液治疗病毒性肺炎的随机对照试验,数据库包括中英文数据库,中文数据库包括CNKI、Wanfang、VIP和CBM,英文数据检索Cochrane Library、Pub Med、Embase,检索时间为至2020年4月1日。结果最终纳入44篇文献合计4304例临床诊断病毒性肺炎患者,网状Meta分析结果显示:3种清热解毒中药注射液有效率均优于利巴韦林组,差异具有统计学意义,但排名顺序差别非常微弱,痰热清注射液(OR=9.1,95%CI[4.4,20.0])、喜炎平注射液(OR=6.6,95%CI[4.5,9.6])与热毒宁注射液(OR=4.9,95%CI[3.5,7.3]);在退热时间的比较中,喜炎平注射液MD=-0.99,95%CI[-1.45,-0.56]与热毒宁注射液MD=-0.96,95%CI[-1.76,-0.19]优于利巴韦林组,差异具有统计学意义,喜炎平注射液排名优于热毒宁注射液;在肺部罗音消失时间的比较中,喜炎平注射液MD=-1.59,95%CI[-2.00,-1.20]与热毒宁注射液MD=-1.51,95%CI[-2.34,-0.65]优于利巴韦林组,差异具有统计学意义,喜炎平注射液排名优于热毒宁注射液;在咳嗽消失时间的比较中,喜炎平注射液优于利巴韦林组,MD=-2.35,95%CI[-3.07,-1.65],差异具有统计学意义,热毒宁注射液、痰热清注射液与利巴韦林组无统计学差异;在住院时间的比较中,3种清热解毒中药注射液均优于利巴韦林组,差异具有统计学意义,热毒宁注射液排名最佳,其次是痰热清注射液,再次是喜炎平注射液;在不良事件发生率的比较中,喜炎平注射液(OR=0.36,95%CI[0.16,0.72])、热毒宁注射液(OR=0.26,95%CI[0.13,0.50])、痰热清注射液(OR=0.21,95%CI[0.041,0.73])不良事件的发生率均低于利巴韦林组,差异具有统计学意义,痰热清注射的不良事件发生率最低。结论3种清热解毒中药注射液有效率均优于利巴韦林组,但排名顺序差别非常微弱。痰热清注射液在降低不良事件发生率方面优势最大,喜炎平注射液在退热时间、肺部罗音消失时间以及咳嗽消失时间三个方面优势最大,热毒宁注射液在缩短住院时间方面优势最大。

Objective To compare the clinical efficacy of Xiyanping(XYP)Injection,Reduning(RDN)Injection and Tanreqing(TRQ)Injection in the treatment of viral pneumonia by Network Meta-analysis(NMA).Methods Three kinds of clearing heat and detoxification traditional Chinese medicine injections in the treatment of viral pneumonia were searched in Chinese and English databases,including CNKI,Wan Fang,VIP and CBM.The data in English was searched in Cochrane Library,Pub Med and Embase until April 1,2020.Results A total of 4304 cases in 44 articles were combined into a clinical diagnosis of patients with viral pneumonia.The network Meta-analysis results showed that three kinds of traditional Chinese medicine injections were better than ribavirin and the difference was statistically significant,but the ranking order difference was very weak:TRQ Injection(OR=9.1,95%CI(4.4,20.0),XYP Injection(OR=6.6,95%CI(4.5,9.6),RDN Injection(OR=4.9,95%CI(3.5,7.3).In the comparison of antipyretic time,XYP Injection(MD=-0.99,95%CI[-1.45,-0.56])was better than ribavirin group(MD=-0.96,95%CI[-1.76,-0.19]).The difference was statistically significant.XYP Injection ranked better than RDN Injection.In the comparison of lung rhomboid disappearance time,XYP Injection(MD=-1.59,95%CI[-2.00,-1.20])was better than ribavirin group(MD=-1.51,95%CI[-2.34,-0.65]).The difference was statistically significant.XYP Injection ranked better than RDN Injection.In the comparison of cough disappearance time,XYP Injection was superior to ribavirin group(MD=-2.35,95%ci[-3.07,-1.65]),and the difference was statistically significant.There was no statistical difference among RDN Injection,TRQ Injection and ribavirin group.In the comparison of hospital stay,the three kinds of traditional Chinese medicine injections were all better than the ribavirin group,and the difference was statistically significant.RDN Injection ranked the best,followed by TRQ Injection and XYP Injection.In the comparison of the incidence of adverse events,the incidence of adverse events in XYP Injection group(OR=0.36,95%CI[0.16,0.72]),RDN Injection group(OR=0.26,95%CI[0.13,0.50])and TRQ Injection group(OR=0.21,95%CI[0.041,0.73])was lower than that in the ribavirin group,and the difference was statistically significant.The incidence of adverse events in TRQ Injection was the lowest.Conclusion The effective rates of three kinds of qingrejiedu Traditional Chinese Medicine Injections were better than those of ribavirin group,but the difference in ranking order was very slight.TRQ Injection had the greatest advantages in reducing the incidence of adverse events.XYP Injection had the greatest advantages in three aspects,namely,the time of antipyretic fever,the time of the disappearance of lung rhomb and the time of the disappearance of cough,and RDN Injection had the greatest advantages in shortening the hospital stay.