中西医协同治疗对免疫功能重建不良HIV/AIDS患者临床疗效的Meta分析

The Clinical Effect of Integrated Traditional Chinese Medicine and Western Medicine in Immuno-reconstitution Deficiency of HIV/AIDS:A Meta-analysis

目的客观评价中西医协同治疗HIV/AIDS患者免疫功能重建不良的临床疗效,为临床治疗提供可靠的循证医学证据。方法计算机检索从建库至2020年1月中国知网、万方数据库、维普中文生物医学期刊数据库、中国医学生物文献库、PubMed数据库、Cochrane图书馆、EMBase数据库。临床研究检索由两名专业文献检索人员分别单独完成,两名评价人员分别单独完成筛选文献、研究偏倚风险评价及数据提取三方面工作,使用Review Manager5.3软件进行数据分析。结果共纳入总样本量为1079例患者的9篇随机对照试验,中西医协同治疗方案治疗HIV/AIDS患者的CD4细胞计数变化情况,治疗组优于对照组(MD=27.92,95%CI:12.62~43.21),治疗3个月,治疗组与对照组临床差异无统计学意义(MD=25.31,95%CI:-2.78~53.41),治疗6个月,治疗组优于对照组(MD=27.45,95%CI:7.09~47.81),治疗12个月,治疗组优于对照组(MD=27.34,95%CI:6.31~48.37);治疗组免疫功能重建有效率高于对照组(OR=1.94,95%CI:1.42~2.65);中西医协同治疗方案治疗HIV/AIDS患者的CD45RO细胞计数变化情况,治疗组与对照组临床差异无统计学意义(MD=12.37,95%CI:-6.71~31.45);中西医协同治疗方案治疗HIV/AIDS患者的CD45RA细胞计数变化情况,治疗组与对照组临床差异无统计学意义(MD=5.67,95%CI:-3.00~14.35)。结论中西医协同治疗在HIV/AIDS患者免疫功能重建不良、免疫功能重建有效率和CD4细胞计数方面具有一定优势,中西医协同治疗组的CD4细胞计数以一种持续稳定的方式促进免疫功能的重建,但临床医师对于HIV/AIDS患者免疫功能重建不良的中医药治疗方式的选择上应进一步行系统评价,以给出最佳的干预措施。

Objective To evaluate the clinical effectiveness of the integrated treatment of traditional Chinese medicine and western medicine to immuno-reconstitution deficiency among HIV/AIDS patients,and to provide evidencebased strategies for clinical treatment.Methods We conducted a literature search in CNKI、WANFANG、CMJD、CBM、PubMed、Cochrane Library and EMBASE database by two independent investigators.Another two investigators extracted data from included studies and conducted a meta-analysis using Review Manager 5.3 software.Results Nine Randomized Controlled Trials(RCTs)involving 1079 patients were analyzed.In general,the CD4 cell count after treatment was better in the integrated treatment group than that in the control group(MD=27.92,95%CI:12.62-43.21).At three months post-treatment,the CD4 count has no statistical significance between the two groups(MD=25.31,95%CI:-2.78-53.41).However,the integrated treatment group was superior to the control group in terms of CD4 cell changes at the six-month(MD=27.45,95%CI:7.09-47.81)and the 12-month post-treatment(MD=27.34,95%CI:6.31-48.37).The treatment effectiveness rate was higher in the integrated treatment group than in the control group(OR=1.94,95%CI:1.42-2.65).There was no statistical significance in numbers of CD45RO(MD=12.37,95%CI:-6.71 to 31.45)and CD45RA(MD=5.67,95%CI:-3.00 to 14.35)cells between the integrated treatment group and the control group.Conclusion The integrated treatment of traditional Chinese and Western medicine has beneficial advantages in treating immuno-reconstitution deficiency among HIV/AIDS patients.The CD4 cell count in the integrated treatment group promoted the reconstruction of immune function in a sustained and stable way indicating a further systematic review is needed to provide favorable evidence for clinical doctors that could contribute to making the best intervention decisions.