中西医结合治疗对肺炎支原体肺炎患儿免疫功能影响的Meta分析

Meta-analysis of Effect of Combined Traditional Chinese and Western Medical Treatment on Immune Function in Children with Mycoplasma Pneumoniae Pneumonia

目的系统评价中西医结合治疗肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)的临床疗效及对患儿免疫功能的影响。方法计算机检索CNKI、CBM、PubMed、VIP及万方数据在线知识服务平台。检索应用中西医结合治疗小儿MPP的临床随机对照试验(RCTs)文献,检索时限为建库至2022年3月,由两名研究人员独立筛选、提取研究资料并评价纳入文献发表偏倚后,采用Revman 5.4软件进行Meta分析。结果共纳入28个RCTs,涉及2789例患者。Meta分析结果显示,与单独应用大环内酯类抗生素相比,中西医结合治疗MPP可明显提高临床总有效率[OR=4.03,95%CI(3.07,5.28),P<0.00001],改善患儿体内细胞免疫紊乱情况,有效升高CD_(3)^(+)水平[SMD=0.97,95%CI(0.53,1.41),P<0.00001]、CD_(4)^(+)水平[SMD=1.21,95%CI(0.86,1.55),P<0.00001]、CD_(4)^(+)/CD_(8)^(+)水平[SMD=1.39,95%CI(0.94,1.83),P<0.00001],降低CD+8水平[SMD=-1.00,95%CI(-1.43,-0.56),P<0.00001],缩短退热时间[SMD=-2.40,95%CI(-3.00,-1.80),P<0.00001]、咳嗽时间[SMD=-2.82,95%CI(-3.55,-2.08),P<0.00001]、肺部啰音消失时间[SMD=-1.89,95%CI(-2.42,-1.37),P<0.00001]。纳入的28项研究中,21项明确说明出现不良反应,共涉及275例患者,其余研究未提及不良反应发生情况。结论当前证据表明中西医结合治疗MPP在改善患儿临床总有效率、细胞免疫紊乱情况、临床症状缓解时间等方面优于单独使用大环内酯类抗生素治疗。但关于中西医结合治疗是否能有效改善患儿体内出现的体液免疫紊乱情况及用药安全性,还需更多高质量研究支持。

Objective To systematically evaluate the clinical efficacy of combined traditional Chinese and Western medicine in the treatment of mycoplasma pneumoniae pneumonia(MPP)and its effect on the immune function of the children.Methods Computer retrieval was conducted on CNKI,CBM,PubMed,VIP and Wanfang Data online knowledge service platforms.The literature of clinical randomized controlled trials(RCTs)applying the combination of traditional Chinese and Western medicine in the treatment of pediatric MPP was searched with a search time frame of the establishment to March 2022,and Meta-analysis was performed using Revman 5.4 software after two researchers independently screened,extracted the study data and evaluated the publication bias of the included literature.Results A total of 28 RCTs involving 2789 patients were included.Meta-analysis showed that compared with macrolide antibiotics alone,the combined treatment of MPP with traditional Chinese and Western medicine significantly increased the overall clinical efficiency[OR=4.03,95%CI(3.07,5.28),P<0.00001],improved the disorders of cellular immunity in children,and effectively increased the levels of CD_(3)^(+) levels[SMD=0.97,95%CI(0.53,1.41),P<0.05],CD_(4)^(+)[SMD=1.21,95%CI(0.86,1.55),P<0.00001]and CD_(4)^(+)/CD_(8)^(+)[SMD=1.39,95%CI(0.94,1.83),P<0.00001]and decreased CD+8 levels[SMD=-1.00,95%CI(-1.43,-0.56),P<0.00001],reduced the time to fever reduction[SMD=-2.40,95%CI(-3.00,-1.80),P<0.00001],the time to cough[SMD=-2.82,95%CI(-3.55,-2.08),P<0.00001]and the time to disappearance of pulmonary rales[SMD=-1.89,95%CI(-2.42,-1.37),P<0.00001].Of the 28 included studies,21 clearly stated the occurrence of adverse reactions,involving 275 patients,and the remaining studies did not mention the occurrence of adverse reactions.Conclusion Current evidence suggests that the combined treatment of MPP with traditional Chinese and Western medicine is superior to macrolide antibiotics alone in terms of improving the overall clinical efficiency,cellular immune disorders and time to resolution of clinical symptoms in children.However,more high-quality studies are needed to determine whether the combination of traditional Chinese and Western medicine is effective in improving the humoral immune disorders that occur in children and the safety of the medication.