督灸改善慢性阻塞性肺病临床疗效及生存质量的Meta分析

Meta-analysis of Governor Moxibustion to Improve Clinical Efficacy and Quality of Life of Chronic Obstructive Pulmonary Disease

目的运用Meta分析方法评价督灸改善慢阻肺稳定期疗效及生存质量的有效性及安全性。方法计算机检索中国期刊全文数据库(CNKI)、中文科技期刊全文数据库维普(VIP)、中国生物医学文献数据库(CBM)、万方数字化期刊全文库、美国国立医学图书馆(PubMed)、Cochrane Library等数据库,检索玉屏风散治疗慢性阻塞性肺病稳定期的所有随机对照试验(RCT),以FEV1%、FEV1/FVC、MMRC、6MWD、CAT、AECOPD、COPD-PRO、ESQ-COPD作为结局指标。2名评价者独立进行文献检索、以Cochrane Handbook推荐的风险偏倚评估工具行文献质量评价并进行数据提取等工作,讨论解决争议,并采用RevMan 5.3软件进行Meta分析。结果纳入11篇RCT文献,涉及1050例患者。与常规治疗相比,Meta分析结果显示:①联合督灸对肺功能第1秒用力呼气容积占预计值百分比(FEV1%)[MD=7.08,95%CI(3.24,10.92),P=0.0003]及FEV1与用力肺活量比值(FEV1/FVC)[MD=9.36,95%CI(1.91,16.80),P=0.01]的改善更佳;②联合督灸能延长6 min步行距离[MD=25.82,95%CI(5.59,46.06),P=0.01];③联合督灸对改良版英国医学研究委员会呼吸问卷(mMRC)分级[MD=-0.57,95%CI(-1.18,0.05),P<0.00001]的改善更佳;④联合督灸对CAT评分[MD=-3.40,95%CI(-5.82,-0.98),P=0.006]的改善更佳;⑤联合督灸在降低急性加重次数[MD=-0.31,95%CI(-0.49,-0.14),P=0.0005]方面更具优势;⑥联合督灸在改善COPD-PRO水平[MD=-3.24,95%CI(-4.92,-1.57),P=0.0001]方面更具优势;⑦联合督灸在改善ESQ-COPD水平[MD=4.02,95%CI(2.14,5.90),P<0.0001]方面更具优势;⑧纳入文献均未报告不良反应。结论督灸联合西医常规治疗干预慢性阻塞性肺病稳定期疗效确切。本研究纳入研究数量偏少,异质性大,证据强度不高,仍需设计高质量临床试验深入研究。

Objective To evaluate the efficacy and safety of governor moxibustion on the efficacy and quality of life of patients with stable chronic obstructive pulmonary disease by Meta-analysis.Methods The Chinese Journal Full-text Database(CNKI),Chinese Science and Technology Periodical Full-text Database(VIP),Chinese Biomedical Literature Database(CBM),Wanfang Digital Journal Full-text Database,United States National Medical Library(PubMed),Cochrane Library and other databases were searched to retrieve all randomized controlled trials(RCTs)of Yupingfeng Powder in the treatment of stable chronic obstructive pulmonary disease.FEV1%,FEV1/FVC,MMRC,6MWD,CAT,AECOPD,COPD-PRO and ESQ-COPD were used as outcome indicators.Two evaluators independently conducted literature retrieval,conducted literature quality evaluation with the risk bias assessment tool recommended by Cochrane Handbook,and conducted data extraction to discuss and resolve disputes.RevMan 5.3 software was used for Meta-analysis.Results Eleven RCT articles involving 1050 patients were included.Compared with conventional treatment,the results of Meta-analysis showed that:①combined governor moxibustion had better improvement in the percentage of forced expiratory volume in the first second to the predicted value(FEV1%)[MD=7.08,95%CI(3.24,10.92),P=0.0003]and the ratio of FEV1 to forced vital capacity(FEV1/FVC)[MD=9.36,95%CI(1.91,16.80),P=0.01];②combined governor moxibustion could prolong the walking distance of 6 min[MD=25.82,95CI(5.59,46.06),P=0.01];③combined governor moxibustion had better improvement in British Medical Research Council Respiratory Questionnaire(mMRC)classification[MD=-0.57,95%CI(-1.18,0.05),P<0.00001];④combined governor moxibustion had better improvement in CAT score[MD=-3.40,95%CI(-5.82,-0.98),P=0.006];⑤combined governor moxibustion had more advantages in reducing the number of acute exacerbations[MD=-0.31,95%CI(-0.49,-0.14),P=0.0005];⑥combined governor moxibustion had more advantages in improving COPD-PRO level[MD=-3.24,95%CI(-4.92,-1.57),P=0.0001];⑦combined governor moxibustion had more advantages in improving[MD=4.02,95%CI(2.14,5.90),P<0.0001];⑧no adverse reactions were reported in the included literature.Conclusion Governor moxibustion combined with routine western medicine treatment is effective in intervening stable phase of chronic obstructive pulmonary disease.The number of studies included in this study is small,the heterogeneity is large,and the evidence strength is not high,so it is still necessary to design high-quality clinical trials for in-depth research.