中西医结合治疗肺部多重耐药菌感染的Meta分析

Meta analysis of pulmonary multidrug-resistant bacterial infection treated by combination of traditional Chinese and Western medicine

目的系统评价中西医结合治疗肺部多重耐药菌感染的临床有效性及安全性。方法通过系统检索中国知网、万方和维普数据库,以及Cochrane Library、PubMed数据库从建库到2020年9月30日所有关于中西医结合治疗肺部多重耐药菌感染的临床研究文献。最终纳入21篇临床研究文献。由两位研究者参照改良Jadad量表独立对文献进行质量评价及提取数据资料。对照组采用常规疗法,共计纳入714例,治疗组采用中药联合常规疗法,共计纳入741例。采用RevMan 5.3软件对中西医结合治疗肺部多重耐药菌感染患者的有效率、肺部感染评分、改善化学指标(降钙素原、C反应蛋白)和不良反应进行系统评价。结果 Meta分析显示:治疗组治疗肺部多重耐药菌感染的有效率明显高于对照组(OR=4.63,95%CI=3.28~6.55),治疗组比对照组能够明显降低肺部感染评分(Z=2.07,P=0.04,MD=-1.08,95%CI=-2.11~-0.06);治疗组在降低C反应蛋白水平方面也比对照组具有优势(Z=2.24,P=0.03,MD=-5.02,95%CI=-9.41~-0.63);治疗组和对照组患者不良反应发生率差异无统计学意义(Z=0.83,P=0.41,OR=1.48,95%CI=0.59~3.72);治疗组与对照组降钙素原水平比较,差异无统计学意义(Z=1.38,P=0.17,MD=-0.28,95%CI=-0.68~0.12)。结论中西医结合治疗肺部多重耐药菌感染安全有效。

Objective To systematically evaluate the clinical effectiveness and safety of traditional Chinese and Western medicine therapy in the treatment of pulmonary multidrug-resistant bacterial infection. Methods We systematically searched Cochrane Clinical Trial Database,PubMed Database,China Knowledge Network(CNKI),VIP and Wanfang Database for all clinical research literature about traditional Chinese medicine therapy in the treatment of multidrug-resistant pulmonary bacterial infection which were enlisted before September 30 th,2020.Twenty-one clinical studies were finally included following our searching strategy.According to the modified Jadad scale,two researchers independently evaluated quality of those literature and extracted data.A total of 714 cases were included in the control group using conventional therapy,and 741 cases in the treatment group using traditional Chinese medicine combined with conventional therapy.RevMan 5.3 software was used to evaluate the effective rate,pulmonary infection score,improvement of chemical indexes(procalcitonin,C-reactive protein(CRP))and adverse reactions of patients. Results Meta-analysis showed that the effective rate of the treatment group was significantly higher than that of the control group(OR=4.63,95%CI=3.28-6.55),and the pulmonary infection score of the treatment group was significantly lower than that of the control group(Z=2.07,P=0.04,MD=-1.08,95%CI=-2.11--0.06).In addition,the treatment group also had advantages in reducing CRP values(Z=2.24,P=0.03,MD=-5.02,95%CI=-9.41--0.63).At the same time,there was no additional increase in the incidence of adverse reactions in patients in the treatment group compared with the control group,suggesting that the safety of the treatment group was better(Z=0.83,P=0.41,OR=1.48,95%CI=0.59-3.72).However,there was no statistically significant difference between the two groups when comparing the values of procalcitonin(Z=1.38,P=0.17,MD=-0.28,95%CI=-0.68-0.12). Conclusion The combination of traditional Chinese and Western medicine is safe and effective in treating pulmonary multidrug-resistant bacteria infection.