加味玉屏风散联合常规西药治疗慢性阻塞性肺疾病稳定期的系统评价与meta分析

Systematic review and meta analysis of additional Yupingfeng powder combined with western medicine treatment at stable period of chronic obstructive pulmonary disease

目的:评价加味玉屏风散联合常规西药治疗慢性阻塞性肺疾病(COPD)稳定期的临床疗效及安全性。方法:运用计算机检索Web of Science、Pubmed、Cochrane Library、维普中文期刊全文数据库、中国知网数据库、万方数据库、中国生物医学文献服务系统,筛选加味玉屏风散联合常规西药治疗COPD稳定期的随机对照临床试验(RCT),由2名研究员按照为本次分析制定的纳排标准独立筛选文献,选定文献后建立Excel表格录入所需数据,制作文献质量评估表,采用RevMan5.3软件进行数据分析。结果:共纳入19篇文献,样本量合计1511例。Meta分析结果显示采用加味玉屏风散联合西医常规治疗能够提高临床有效率[OR=0.26,95%CI(0.18,0.37)],可改善患者肺功能FEV1占预计值百分比(%)[MD=4.61,95%CI(2.43,6.79)],并且能够提高患者运动耐力6MWD[MD=43.90,95%CI(29.48,58.32)],提高患者体内的IgA水平[MD=0.25,95%CI(0.17,0.34)]。结论:加味玉屏风散联合常规西药治疗COPD稳定期可提高客观疗效,改善肺功能,提高免疫功能,且不良反应较小。但鉴于本次分析纳入的研究大多质量低下,结论证据支持力度较弱,有待更多方法学质量高,设计严谨,多中心的随机对照试验加以验证。

Objective To systematically evaluate the effect and safety of additional Yupingfeng powder combined with western medicine treatment for the stable period of chronic obstructive pulmonary disease(COPD).Method Databases including Pubmed,Web of Science,Cochrane Library,CNKI,VIP,CBM,and Wanfang,were searched for relevant randomized controlled trialsfor Chinese and English literature about randomized controlled trials of additional Yupingfeng in the treatment of COPD on stable stage which were published from the establishment of the database to December 2019.Two researchers independentlyscreened for selected studies according to the inclusion and exclusion criteria and extracted data.Methodological quality was evaluated using the Cochrane Risk of Bias tool.Meta analysis was performed using Revman 5.3 software.Results Nineteen randomized controlled trials including 1511 patients with COPD were meta-analyzed.The total sample size was 1511.The results showed that the treatment group with additional Yupingfeng powder could improve the clinical efficacyOR=0.26,95%CI(0.18,0.37),FEV1 percentage of the estimated value MD=4.61,95%CI(2.43,6.79),6MWDMD=43.90,95%CI(29.48,58.32)and patient's immunity IgAMD=0.25,95%CI(0.17,0.34)and can mitigate cough effectivelyMD=-0.34,95%CI(-0.46,-0.23).ConclusionAdditional Yupingfeng powder combined with routine treatment for COPD have more advantages than conventional treatment alone in improving the clinical efficacy,lung function,immune function and have less adverse events.As most of the included studies in this systematic evaluation had poor quality,the evidence to support conclusion was weak,so it was necessary to conduct more multi-center clinical trials with high quality methods and rigorous design.