4367例成人流行性感冒患者证候分布特征的Meta分析

Distribution characteristics of traditional Chinese medicine syndromes in 4 367 adult influenza patients: a Meta-analysis

目的:系统评价成人流行性感冒(流感)患者的中医证候分布特征,为流感的中医辨证论治提供依据。方法:检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据、维普数据库(VIP)、PubMed、Embase、Cochrane Library数据库,收集成人流感中医证候分布特征的横断面研究。依据JBI循证卫生保健中心研制的横断面研究偏倚风险评估工具进行文献质量评价,应用Stata 15.1软件对纳入的研究合并效应量进行Meta分析。结果:共纳入11项研究、4367例流感患者。JBI质量评价结果显示,样本量计算的风险偏倚较高,取样方式和应答率条目的描述不清楚。规范后的流感证候共17种,对事件发生数≥50例的证候进行Meta分析,结果显示发生频率≥10%且差异有统计学意义的证候有9种,前5种依次是风热犯卫证〔n=1583,合并发生频率(RATE)=34.3%,95%可信区间(95%CI)为22.2%~46.3%〕、表寒里热证(n=1122,RATE=36.1%,95%CI为21.2%~51.1%)、风寒束表证(n=860,RATE=19.4%,95%CI为10.7%~28.0%)、热毒壅肺证(n=217,RATE=17.1%,95%CI为9.1%~25.0%)、卫气同病证(n=184,RATE=38.8%,95%CI为14.2%~63.5%)。亚组分析显示,流感证候可能存在地区差异,风热犯卫、热毒壅肺证候分布频率南方地区(RATE分别为36.5%、18.6%)高于北方地区(RATE分别为30.9%、15.4%),风寒束表、表寒里热证候分布频率北方地区(RATE分别为23.8%、40.1%)高于南方地区(RATE分别为15.7%、32.3%)。结论:流感的常见中医证候为风热犯卫证、表寒里热证、风寒束表证、热毒壅肺证、卫气同病证、风热夹湿伤表证、风寒夹湿伤表证、卫分证、湿热在表证9种,可为流感的准确辨证治疗提供参考。

Objective To systematically evaluate the distribution characteristics of traditional Chinese medicine(TCM)syndromes in adult influenza patients and to provide a basis for the TCM syndrome differentiation of influenza.Methods The CNKI,CBM,Wanfang,VIP,PubMed,Embase,Cochrane Library databases were searched to collect cross-sectional studies on the distribution pattern of TCM syndromes in adult patients with influenza.The risk of bias assessment tool for cross-sectional studies developed by the Joanna Briggs Institute(JBI)evidence-based health care center was used to evaluate the literature quality,and the Stata 15.1 software was used to conduct a Meta-analysis of the pooled effect sizes of the included studies.Results A total of 11 studies with 4367 influenza patients were included.Quality assessment results of JBI showed that the risk bias was higher in the sample size calculation,and the description of sampling modalities and response rate was unclear.There were 17 influenza syndromes after specification,and a single group rate Meta-analysis was performed of the syndromes with≥50 incident cases showed that there were 9 syndromes with an incidence≥10%and statistical significance,the top 5 syndromes were syndrome of wind and heat invading the defense[n=1583,RATE=34.3%,95%confidence interval(95%CI)was 22.2%-46.3%],syndrome of exterior cold and interior heat(n=1122,RATE=36.1%,95%CI was 21.2%-51.1%),syndrome of wind-cold fettering the exterior(n=860,RATE=19.4%,95%CI was 10.7%-28.0%),syndrome of heat and toxin in the lung(n=217,RATE=17.1%,95%CI was 9.1%-25.0%),and syndrome of disease involving both defense phase and qi phase(n=184,RATE=38.8%,95%CI was 14.2%-63.5%).The results of the subgroup analysis in different geographical regions showed that the frequency of distribution of syndrome of wind and heat invading the defense and heat and toxin in the lung was higher in the South(RATE:36.5%,18.6%)than in the North(RATE:30.9%,15.4%),and the frequency of distribution of syndrome of wind-cold fettering the exterior and exterior cold and interior heat in the North(RATE:23.8%,40.1%)was higher than that in the South(RATE:15.7%,32.3%).Conclusions There are 9 common TCM syndromes of influenza,including wind and heat invading the defense syndrome,exterior cold and interior heat syndrome,wind-cold fettering the exterior syndrome,heat and toxin in the lung syndrome,disease involving both defense phase and qi phase syndrome,wind and heat complicated by dampnessinvading the surface syndrome,wind and cold complicated by dampnessinvading the surface syndrome,defense phase syndrome and dampness and heatinvading the surface syndrome,which can provide a reference for the TCM syndrome differentiation and treatment of influenza.