中医药对新型冠状病毒肺炎(COVID-19)恢复期患者肺功能影响的Meta分析

Meta-analysis of the effects of traditional Chinese medicine on lung function of COVID-19 patients during disease recovery

目的系统评价中医药对新型冠状病毒肺炎(COVID-19,简称:新冠肺炎)恢复期患者的肺功能影响,以期为临床决策及后续临床研究的开展提供参考。方法计算机检索中国知网(CNKI)、万方数据库(WanFang)、中国生物医学文献数据库(SinoMed)、维普期刊数据库(VIP)、PubMed、The Cochrane Library、EMbase数据库,检索时间为建库至2022年7月。由2名研究者按照纳入与排除标准独立筛选文献、提取数据且评估纳入研究的偏倚风险及方法学质量,采用Review Manager 5.4软件进行Meta分析。结果共纳入9项研究,其中5项随机对照试验、2项非随机对照试验、2项队列研究,纳入研究共包含1101例新冠肺炎恢复期患者。Meta分析结果显示:(1)针刺、中西医结合康复训练,可有效提升患者第一秒用力呼气容积(forced expiratory volume in one second,FEV1)水平(SMD=1.43,95%CI[1.10,1.75],P<0.00001)。(2)中西医结合康复训练可提升患者第一秒用力呼气容积占用力肺活量的百分比(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)(MD=12.12,95%CI[9.46,14.79],P<0.00001)。(3)中药联合常规康复训练可有效降低患者改良医学研究学会呼吸困难量表(modified Medical Research Council,mMRC)评分(MD=-0.16,95%CI[-0.17,-0.15],P<0.00001)。(4)针刺、中药可提升肺部CT好转率(RR=1.14,95%CI[1.06,1.23],P=0.0003)。结论中医药可提升新冠肺炎恢复期患者FEV1及FEV1/FVC水平、降低mMRC评分及促进肺部CT好转率,促进新冠肺炎恢复期患者康复。受纳入研究数量限制,结论尚需更多高质量研究予以验证。

Objective Systematically assess the effect of traditional Chinese medicine on the lung function of COVID-19 patients during disease recovery period to provide evidences for clinical studies.Methods Databases were up to July 2022;PubMed,Medline,EMbase,CNKI,Wanfang,and VIP.According to the inclusion and exclusion criteria,two independent reviewers selected studies,extracted data,and assessed the risk of bias and methodological quality.Meta-analysis was carried out by the software of review manager 5.4.Results A total of nine studies were included,five randomized controlled trials,two non-randomized controlled trials,and two cohort studies were found,comprising 1101 participants.Meta-analysis showed that post-intervention,(1)Acupuncture and integrated traditional Chinese and Western medicine rehabilitation therapy could significantly improve forced expiratory volume in one second(FEV1)(SMD=1.43,95%CI[1.10,1.75],P<0.00001)when compared with a control intervention.(2)Integrated Traditional Chinese and Western Medicine Rehabilitation therapy could be increased forced expiratory volume in one second/forced vital capacity(FEV1/FVC)(MD=12.12,95%CI[9.46,14.79],P<0.00001).(3)Chinese medicine combined with routine rehabilitation treatment effectively improved the degree of modified Medical Research Society Dyspnea Scale(MMRC)(MD=-0.16,95%CI[-0.17,-0.15],P<0.00001).(4)Chinese medicine and acupuncture significantly improved the lung CT recovery rate in patients(RR=1.14,95%CI[1.06,1.23],P=0.0003).Conclusion Traditional Chinese medicine therapy can increase the levels of FEV1 and FEV1/FVC,decrease the scores of the mMRC,and promote the lung CT recovery rate.Owing to the limited quantity of included studies,more high-quality studies are needed to verify the conclusions.