疏风解毒辅助治疗AECOPD疗效的Meta分析及GRADE评价

Meta Analysis and GRADE Evaluation of the Curative Effect of Shufeng Jiedu Adjuvant Treatment for AECOPD

目的:系统评价疏风解毒辅助治疗AECOPD患者的肺功能、血气分析、感染指标的影响。方法:计算机检索PubMed、EMbase、知网、中国生物医学文献数据库、The Cochrane Library、VIP以及WanFang Data数据库等,整合疏风解毒辅助治疗COPD患者的相关随机对照试验(RCT),检索时限均为从建库至2019年3月。两位研究学者先是进行文献筛选、资料收集,对纳入到研究当中的偏倚风险进行评估以后,要通过RevMan 5.3软件加以分析研究,并根据GRADE评价系统进行证据质量评价。结果:共纳入9个RCT,760例患者,Meta分析结果显示:疏风解毒组的肺功能FEV1[MD=0.44,95%CI(0.33,0.56),P<0.0001]明显高于对照组;疏风解毒组的肺功能FVC[MD=0.39,95%CI(0.19,0.58),P=0.0001]明显高于对照组;疏风解毒组的肺功能FEV1/FVC[MD=6.90,95%CI(1.86,11.93),P=0.007]明显高于对照组;疏风解毒组的血气分析PO2[MD=8.41,95%CI(5.09,11.72),P<0.0001]明显高于对照组;疏风解毒组的血气分析PCO2[MD=-4.77,95%CI(-7.50,-2.04),P=0.0006]明显低于对照组;疏风解毒组的感染指标CRP[MD=-6.88,95%CI(-9.88,-3.87),P<0.0001]明显低于对照组;疏风解毒组的感染指标PCT[MD=-0.70,95%CI(-1.15,-0.25),P=0.002]明显低于对照组;疏风解毒组的感染指标WBC[MD=-2.54,95%CI(-3.15,-1.93),P=<0.0001]明显低于对照组,以上差异均有统计学意义。根据GRADE评价系统,其中结局指标血气分析PO2、PCO2为中等质量证据,FEV1、FVC、FEV1/FVC、CRP、PCT、WBC为低质量证据。结论疏风解毒辅助治疗AECOPD患者与常规组相比,前者可改善患者肺功能,提高患者血气分析的PO2分压,降低PCO2分压,降低感染指标,但研究方法学质量总体偏低。考虑本次Meta体系中所用数量、质量都有限,以上结论依然要进行更多研究才能得到验证。

Objective:To systematically evaluate the influence of lung function,blood gas analysis and infection index in patients with AECOPD assisted by Shufeng Jiedu.Methods:PubMed,EMbase,CNKI,Chinese biomedical literature database,The Cochrane Library,VIP and Wanfang Data databases were searched by computer,and related randomized controlled trials(RCTS)of patients with AECOPD were integrated.The retrieval time was from The database to March 2019.After literature screening and data collection,the two researchers will evaluate the risk of bias included in the study,analyze and study with RevMan 5.3 software,and evaluate the evidence quality according to the GRADE evaluation system.Results:A total of 9 RCTS and 760 patients were included.Meta analysis,the results showed that lung function FEV1[MD=0.44,95%CI(0.33,0.56),P<0.0001 in the Shufeng Jiedu group was significantly higher than that in the control group.Lung function FVC[MD=0.39,95%CI(0.19,0.58),P=0.0001]in the Shufeng Jiedu group was significantly higher than that in the control group.Lung function FEV1/FVC[MD=6.90,95%CI(1.86,11.93),P=0.007)in the Shufeng Jiedu group was significantly higher than that in the control group.The blood gas PO2[MD=8.41,95%CI(5.09,11.72),P<0.0001)of the Shufeng Jiedu group was significantly higher than that of the control group.The PCO2[MD=-4.77,95%CI(-7.50,-2.04),P=0.0006)of the Shufeng Jiedu group was significantly lower than that of the control group.The infection index CRP[MD=-6.88,95%CI(-9.88,-3.87),P<0.0001 in the Shufeng Jiedu group was significantly lower than that in the control group.The infection index PCT[MD=-0.70,95%CI(-1.15,-0.25),P=0.002 in the Shufeng Jiedu group was significantly lower than that in the control group.The infection index WBC[MD=-2.54,95%CI(-3.15,-1.93),P=<0.0001 in the Shufeng Jiedu group was significantly lower than that in the control group,and the above differences were statistically significant.According to the GRADE evaluation system,PO2,PCO2 and FEV1,FVC,FEV1/FVC,CRP,PCT and WBC are the medium-quality evidences.Conclusion compared with the conventional group,the former can improve the pulmonary function of COPD patients,improve the PO2 partial pressure of blood gas analysis,reduce the PCO2 partial pressure and reduce the infection index,but the overall quality of the research methodology is low.Considering the limited quantity and quality used in this Meta system,more studies are needed to verify the above conclusions.