补肺益肾法治疗慢性阻塞性肺疾病的Meta分析

Meta-analysis of the treatment of chronic obstructive pulmonary disease by tonifying lung and kidney

目的:探讨补肺益肾法治疗慢性阻塞性肺疾病的随机对照试验(RCT)。方法:计算机检索中国知网(CNKI)、维普(VIP)、万方(WanFang)、Cochrane Library、EMbase、PubMed等数据库,检索时间为建库至2020年3月,分别由2名评价员根据纳排标准互筛文献,用Excel 2010软件进行资料提取,Rev Man5.3软件进行Meta分析。结果:最终纳入21篇RCT,Meta分析结果显示:与常规治法相比,加用补肺益肾法能够明显改善肺功能[WMD=1.69,95%CI(1.36,2.01),P<0.00001]、降低中医证候积分[WMD=-3.43,95%CI(-4.93,-1.93),P<0.00001]、提高生活质量[WMD=-5.90,95%CI(-8.95,-2.85),P=0.0001]、调节血清免疫球蛋白[WMD=0.37,95%CI(0.31,0.44),P<0.00001]、提高6 MWD[WMD=39.83,95%CI(18.10,61.56),P=0.0003]、改善CAT[WMD=-1.68,95%CI(-2.05,-1.30),P<0.00001],差异均具有统计学意义(P<0.0.05),对于改善T淋巴细胞亚群[MD=0.96,95%CI(-0.10,2.03),P=0.08]无统计学意义(P>0.0.05)。结论:补肺益肾法在改善患者肺功能、降低中医症候积分、提高生活质量、调节免疫球蛋白、提高6WMD、改善CAT方面疗效更好,但对于T淋巴细胞亚群的改善与对照组疗效相当。由于本文纳入的样本数量及质量有限,因此需开展更多大样本、设计严谨的多中心随机对照试验进行验证。

Objective:A randomized controlled trial(RCTS)of lung tonifying kidney and lung in the treatment of chronic obstructive pulmonary disease(COPD)by meta-analysis.Methods:All related literatures were retried from databases such as CNKI,VIP,WanFang,Cochrane Library,EMbase,PubMed and selected by two specialists.The retrieval time was from the database construction to March 2020.Data were extractedby Excel 2010 software,and analyzed by Meta analysis with Rev Man 5.3 software.Results:Finally,21 RCTS were included.Meta-analysis results show that compared with the conventional treatment,the method of supplementing lung and tonifying kidney can obviously improve lung functionMD=1.69,95%CI(1.36,2.01),P<0.00001),reduce TCM syndrome scoreWMD=39.83,95%CI(18.10,61.56),P=0.0003,improve life qualityWMD=-5.90,95%CI(-8.95,-2.85),P=0.0001 regulates serum immunoglobulinWMD=0.37,95%CI(0.31,0.44),P<0.00001,improve 6 MWDMD=39.83,95%CI(18.10,61.56),P=0.0003,improve CAT WMD=-1.68,95%CI(-2.05,-1.30),P<0.00001.The differences were all statistically significant.But it showed no significant difference in improving T lymphocyte subsets WMD=0.96,95%CI(-0.10,2.03),P=0.08.Conclusions:Lung-tonifying kidney-tonifying method shows better efficacy in improving lung function,reducing TCM syndrome score,improving life quality,improving immunoglobulin,improving 6 MWD,improving CAT,but the efficacy in improving t-lymphocyte subgroup was similar to other treatments.Due to the limited quantity and quality of samples included in this paper,more multicenter randomized controlled trials with rigorous design of large samples should be carried out for verification.