不同中成药辅助治疗社区获得性肺炎疗效及安全性的网状Meta分析

Network Meta-analysis of different Chinese patent medicines in the adjuvant treatment of community-acquired pneumonia

目的采用网状Meta分析探讨不同中成药辅助治疗社区获得性肺炎(CAP)的疗效及安全性。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库及PubMed、Web of Science、Embase、the Cochrane Library中公开发表的中成药治疗CAP的随机对照试验(RCTs),检索时限为建库至2023年5月。由2位研究员独立筛选文献,采用Cochrane风险偏倚评估工具RoB 2.0对纳入文献进行方法学质量评价,应用Stata 15.0软件进行网状Meta分析,并绘制漏斗图评估文献发表偏倚。结果最终纳入31篇RCTs,共包含3111例患者。网状Meta分析结果显示,临床总有效率的累积排序概率曲线下面积(SUCRA)排序为:十味龙胆花颗粒>疏风解毒胶囊>连花清瘟胶囊/颗粒>蒲地蓝消炎口服液>西药;退热时间的SUCRA排序为:十味龙胆花颗粒>连花清瘟胶囊/颗粒>疏风解毒胶囊>蒲地蓝消炎口服液>西药;咳嗽消失时间的SUCRA排序为:十味龙胆花颗粒>疏风解毒胶囊=连花清瘟胶囊/颗粒>蒲地蓝消炎口服液>西药;肺部啰音消失时间的SUCRA排序为:十味龙胆花颗粒>疏风解毒胶囊>连花清瘟胶囊/颗粒>西药。与单独西药治疗相比,十味龙胆花颗粒、疏风解毒胶囊、连花清瘟胶囊/颗粒、蒲地蓝消炎口服液联合西药治疗的临床总有效率均较高。与单独西药治疗相比,十味龙胆花颗粒、连花清瘟胶囊/颗粒、疏风解毒胶囊联合西药治疗者的退热时间、咳嗽消失时间、肺部啰音消失时间更短;与连花清瘟胶囊/颗粒、疏风解毒胶囊、蒲地蓝消炎口服液联合西药相比,十味龙胆花颗粒联合西药治疗者退热时间、咳嗽消失时间更短;与疏风解毒胶囊、连花清瘟胶囊/颗粒联合西药相比,十味龙胆花颗粒联合西药治疗者的肺部啰音消失时间更短。研究均未出现严重不良反应。漏斗图结果显示,有少部分散点分布在下部,散点存在不对称性,故文献存在一定的发表偏倚。结论连花清瘟胶囊/颗粒、疏风解毒胶囊、蒲地蓝消炎口服液、十味龙胆花颗粒联合西药治疗CAP均可增强疗效,但十味龙胆花颗粒的治疗效果最好,疏风解毒胶囊次之。

Objective To evaluate the efficacy and safety of different Chinese patent medicines in the adjuvant treatment of CAP by network Meta-analysis.Methods RCTs about different Chinese patent medicines in the adjuvant treatment of CAP were searched in CNKI,WanFang Data,VIP,CBM and PubMed,Web of Science,Embase,the Cochrane Library,the search period was from database construction time to May 2023.Literatures were screened and data extracted by two researchers,the quality of the included literatures were evaluated by the Cochrane Risk of Bias Assessment Tool RoB 2.0,network Meta-analysis was performed applying Stata 15.0 software,and finally a funnel plot was created to assess publication bias.Results Finally,a total of 31 RCTs were included,including 3111 cases of patients.Network Meta-analysis results showed that,SUCRA of total effective rate was Shiwei Longdanhua granules>Shufeng Jiedu capsules>Lianhua Qingwen capsules/granules>Pudilan Xiaoyan oral liquid>western medicine;SUCRA of antipyretic time was Shiwei Longdanhua granules>Lianhua Qingwen capsules/granules>Shufeng Jiedu capsules>Pudilan Xiaoyan oral liquid>western medicine;SUCRA of cough disappearance time was Shiwei Longdanhua granules>Shufeng Jiedu capsules=Lianhua Qingwen capsules/granules>Pudilan Xiaoyan oral liquid>western medicine;SUCRA of lung rale disappearance time was Shiwei Longdanhua granules>Shufeng Jiedu capsules>Lianhua Qingwen capsules/granules>western medicine.Compared with western medicine treatment,Shiwei Longdanhua granules,Shufeng Jiedu capsules,Lianhua Qingwen capsules/granules,Pudilan Xiaoyan oral liquid combined with western medicine had higher total effective rate.Compared with western medicine treatment,Shiwei Longdanhua granules,Lianhua Qingwen capsules/granules,Shufeng Jiedu capsules combined with western medicine had shorter antipyretic time,cough disappearance time and lung rale disappearance time;Comapred with Lianhua Qingwen capsules/granules,Shufeng Jiedu capsules,Pudilan Xiaoyan oral liquid combined with western medicine,Lianhua Qingwen capsules/granules combined with western medicine had shorter antipyretic time,cough disappearance time;Compared with Shufeng Jiedu capsules,Lianhua Qingwen capsules/granules combined with western medicine,Shiwei Longdanhua granules combined with western medicine had shorter lung rale disappearance time.No serious adverse reactions occurred in the study.The funnel chart showed that a small number of scattered points were distributed in the lower part,and the scattered points were asymmetric,so there was a certain publication bias in the literatures.Conclusion Lianhua Qingwen capsules/granules,Shufeng Jiedu capsules,Pudilan Xiaoyan oral liquid and Shiwei Longdanhua granules combined with western medicine can all enhance the curative effect for CAP,but Shiwei Longdanhua granules has the best therapeutic effect,followed by Shufeng Jiedu capsules.