中医药治疗腺样体肥大的Meta分析及用药规律研究

Study on Meta Analysis and Medication Regularity of Traditional Chinese Medicine in Treatment of Adenoid Hypertrophy

目的:系统评价中医药治疗腺样体肥大的疗效性,并探讨其用药规律。方法:收集自2017年1月至2022年4月在中国知网、维普、万方和中国生物医学文献服务系统中文数据库中公开发表的关于中药复方治疗腺样体肥大的随机对照试验。根据Cochrane偏倚风险工具进行文献质量评价,采用RevMan 5.3及Stata 16.0软件行Meta分析,并在此基础上,总结中医药治疗腺样体肥大的用药规律。结果:共纳入25项随机对照试验,2008例患者。Meta分析结果示,中医药在提高临床总有效率[OR=4.14,95%CI(3.16,5.42),P<0.05],改善鼻塞[WMD=-1.17,95%CI(-1.74,-0.60),P<0.05]、打鼾[WMD=-1.23,95%CI(-1.73,-0.74),P<0.05]、张口呼吸症状[WMD=-1.46,95%CI(-2.09,-0.82),P<0.05],降低鼻咽侧位片A/N值[WMD=-1.08,95%CI(-1.47,-0.69),P<0.05]、OSA-18评分[WMD=-1.80,95%CI(-2.92,-0.68),P<0.05]以及复发率[OR=0.24,95%CI(0.12,0.49),P<0.05]方面均优于单纯西医治疗。数据挖掘分析,中医药治疗腺样体肥大使用频次较高的前五位中药为甘草、浙贝母、夏枯草、陈皮、茯苓。药物类别多属清热药、化痰止咳平喘药、补虚药、解表药。复杂网络分析治疗腺样体肥大核心处方为二陈汤化裁加减。结论:相比西医治疗,中医药治疗腺样体肥大疗效确切、肯定,在选方用药时注重分期辨治,标本兼顾,灵活用药。

Objective To evaluate the efficacy of traditional Chinese medicine(TCM)in adenoid hypertrophy systematically and explore its medication law.Methods Randomized controlled trials on the treatment of adenoid hypertrophy with TCM compounds published from January 2017 to April 2022 were collected from CNKI,VIP,Wanfang and SinoMed,The quality of literature was evaluated by using Cochrane Risk of Bias tool,and a meta-analysis was conducted with RevMan 5.3 and Stata 16.0 software.On this basis,the medication law of TCM in adenoid hypertrophy was summarized.Results A total of 25 randomized controlled trials(2008 cases)were included.The results of meta-analysis indicated that TCM was superior to western medicine alone in the improvement of clinical overall response rate[OR=4.14,95%CI(3.16,5.42),P<0.05],the symptoms of rhinobyon[WMD=-1.17,95%CI(-1.74,-0.60),P<0.05],snoring[WMD=-1.23,95%CI(-1.73,-0.74),P<0.05],open-mouth breathing symptoms[WMD=-1.46,95%CI(-2.09,-0.82),P<0.05],decrease of A/N value of lateral nasopharynx film[WMD=-1.08,95%CI(-1.47,-0.69),P<0.05],OSA-18 score[WMD=-1.80,95%CI(-2.92,-0.68),P<0.05]and recurrence rate[OR=0.24,95%CI(0.12,0.49),p<0.05].decrease of A/N value of lateral nasopharynx film.As manifested by the data mining analysis,the top five TCMs with high frequency in the treatment of adenoid hypertrophy were licorice,fritillaria thunbergii,prunella vulgaris,tangerine peel and poria cocos.Most of the drug categories were heat-clearing drugs,phlegm-resolving and cough-stopping and asthma-appeasing drugs,deficiency-reinforcing drugs,and exterior syndrome-relieving drugs.According to complex network analysis,the core prescription for adenoidal hypertrophy was Erchen Decoction(to be added or subtracted).Conclusion Compared with western medicine,TCM has a proved and definite effect on adenoid hypertrophy.During the selection of prescription and use of drugs,we should pay attention to differentiate syndromes by stage for treatment,address both symptoms and root causes and use drugs flexibly.