中药注射剂联合抗病毒类西药治疗流行性感冒的贝叶斯网状Meta分析

Bayesian network Meta-analysis of traditional Chinese medicine injections combined with antiviral western medicine in treatment of influenza

运用贝叶斯网状Meta分析系统评价中药注射剂联合抗病毒类西药治疗流行性感冒的有效性及安全性。应用计算机检索四大中文数据库(CNKI、Wanfang、VIP、CBM)及三大英文数据库(PubMed、EMbase、Cochrane Library)中关于中药注射剂联合抗病毒类西药治疗流感对比单纯抗病毒类西药(或加用安慰剂)治疗流感,或2种不同中药注射液联合抗病毒类西药治疗流感之间比较的随机对照研究,检索时间为各数据库建库至2020年7月。由2位研究人员独立按照制定好的纳、排标准对文献进行筛选以及数据提取。采用Cochrane 5.1偏倚风险评估工具对纳入的文献进行质量评价,并利用ADDIS 1.16.8软件及Stata 14.0软件进行数据分析。共纳入49篇文献,5 061例患者,涉及热毒宁注射液、喜炎平注射液、痰热清注射液、炎琥宁注射液、清开灵注射液及双黄连注射液6种。网状Meta分析结果显示,(1)总有效率方面,6种中药注射剂联合西药抗病毒治疗均优于单纯西药抗病毒治疗,概率排序第1为双黄连注射液联合西药抗病毒治疗;(2)不良反应率方面,所有组间差异均无统计学意义,但概率排序第1为热毒宁注射液联合西药抗病毒治疗,其副作用最小;(3)退热时间方面,炎琥宁注射液、喜炎平注射液及痰热清注射液联合西药抗病毒治疗均优于单纯西药抗病毒治疗,概率排序第1为喜炎平注射液联合西药抗病毒治疗;(4)镇咳缓解时间方面,清开灵注射液及痰热清注射液联合西药抗病毒治疗均优于单纯西药抗病毒治疗,且清开灵注射液优于炎琥宁注射液,排序第1为清开灵注射液联合西药抗病毒治疗;(5)住院时间方面,喜炎平注射液、痰热清注射液及热毒宁注射液联合西药抗病毒治疗均优于单纯西药抗病毒治疗,概率排序第1为热毒宁注射液联合西药抗病毒治疗,其综合住院时间最短。由于纳入研究的文献量较少、总体质量较低,因此,应谨慎全面地看待该研究结果,今后仍需进行多中心、大样本临床随机对照试验予以验证。

To systematically evaluate the efficacy and safety of traditional Chinese medicine injections combined with antiviral wes-tern medicine in the treatment of influenza by Bayesian network Meta-analysis. Four Chinese databases(CNKI, Wanfang, VIP, CBM) and three English databases(PubMed, EMbase, Cochrane Library) were retrieved by computer for randomized controlled trials(RCT) about the comparison between the combined administration of traditional Chinese medicine injections with antiviral western medicine(or with placebo) and the single administration of antiviral western medicine in the treatment of influenza, or the comparison between two different traditional Chinese medicine injections combined with antiviral western medicine in the treatment of influenza. The retrieval time was from the establishment of the databases to July 2020. Two researchers independently screen out the literatures and extracted the data according to the inclusion criteria and exclusion criteria. The included studies were evaluated by the Cochrane 5.1 bias risk assessment tool, and data analysis was conducted by ADDIS 1.16.8 and Stata 14.0. A total of 49 literatures about 5 061 cases were included finally, involving six traditional Chinese medicine injections, namely Reduning Injection, Xiyanping Injection, Tanreqing Injection, Yanhuning Injection, Qingkailing Injection and Shuanghuanglian Injection. The results of network Meta-analysis,(1)in terms of total effective rate, 6 traditional Chinese medicine injections combined with antiviral western medicine was better than antiviral western medicine alone. In terms of probability sorting, Shuanghuanglian Injection combined with antiviral western medicine ranked first.(2)There was no significant statistical difference in adverse reaction rate among all groups, but Reduning Injection ranked first in the probability sorting, due to the least side effects.(3)In terms of antipyretic time, Yanhuning Injection, Xiyanping Injection and Tanreqing Injection combined with antiviral western medicine was better than antiviral western medicine alone and Xiyanping Injection ranked first in the probability sorting.(4)In terms of cough relief time, Qingkailing Injection and Tanreqing Injection combined with antiviral western medicine was better than antiviral western medicine alone and Qingkailing Injection was superior to Yanhuning Injection. Qingkailing Injection combined with antiviral western medicine ranked first in the probability sorting.(5)In terms of the length of hospital stay, Xiyanping Injection, Tanreqing Injection and Reduning Injection combined with antiviral western medicine was superior to antiviral western medicine alone, and Reduning Injection ranked first in the probability sorting due to the shortest hospital stay. Because of the small quantity and low quality of included studies, the results of this study shall be regarded cautiously and comprehensively. In the future, multi-center, large-sample and clinical randomized controlled trials shall be conducted to verify the results.