清肺化痰法治疗痰热壅肺型社区获得性肺炎的系统评价

Systematic review of lung-clearing and phlegm-resolving method for community acquired pneumonia with phlegm-heat obstructing lung syndrome

目的系统评价清肺化痰法治疗痰热壅肺型社区获得性肺炎(CAP)的临床疗效。方法计算机检索万方数据知识服务平台(WanFang Data)、中国知网(CNKI)、中国生物医学数据库(SinoMed)、Embase、PubMed等数据库中清肺化痰法治疗痰热壅肺型CAP的相关文献,文献发表时间为建库至2023年10月10日。借助Cochrane 5.1.0系统手册评估工具评价文献质量,运用RevMan 5.3软件进行Meta分析。结果(1)本研究共纳入14篇文献,涉及1029例患者,其中试验组521例、对照组508例。(2)Meta分析结果显示,试验组在肺炎吸收率、临床有效率、中医证候有效率方面高于对照组[OR=2.79,95%CI(1.78,4.38),P<0.00001;OR=3.57,95%CI(2.03,6.29),P<0.00001;OR=4.03,95%CI(2.15,7.59),P<0.00001];试验组中医证候改善率优于对照组[SMD=-0.81,95%CI(-1.39,-0.22),P<0.01];在实验室检查方面,试验组较对照组能更好地控制白细胞计数[SMD=-0.78,95%CI(-1.10,-0.45),P<0.01]、C反应蛋白[SMD=-1.52,95%CI(-2.20,-0.85),P<0.01]、降钙素原[SMD=-1.84,95%CI(-2.85,-0.83),P<0.01]、中性粒细胞百分比[SMD=-0.64,95%CI(-0.97,-0.32),P<0.01]水平;在症状改善时间方面,试验组较对照组能更好地缩短咳嗽缓解时间[SMD=-1.59,95%CI(-2.54,-0.64),P<0.01]、发热缓解时间[SMD=-1.09,95%CI(-1.73,-0.44),P<0.01]、肺部啰音缓解时间[SMD=-1.94,95%CI(-3.31,-0.57),P<0.01]。结论与单纯采用常规西医治疗相比,加用清肺化痰法治疗痰热壅肺型CAP能够更好促进肺炎吸收率、提高临床有效率、改善中医证候、控制实验室指标及缩短症状缓解时间;但纳入的文献数量、质量有限,相关结论有待进一步验证。

Objective To systematically evaluate the clinical effects of lung-clearing and phlegm-resolving method in treating community acquired pneumonia(CAP)with phlegm-heat obstructing lung syndrome.Methods A comprehensive search was conducted in databases including WanFang Data,China National Knowledge Infrastructure(CNKI),SinoMed,Embase,and PubMed for relevant studies on the lung-clearing and phlegm-resolving method for CAP with phlegm-heat obstructing lung syndrome,published up to October 10,2023.The quality of the included studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0,and a Metaanalysis was conducted using RevMan 5.3.Results①Fourteen papers involving 1029 patients were included,with 521 in the experimental group and 508 in the control group.②Meta-analysis results showed that the experimental group had higher rates of pneumonia resolution,greater clinical effectiveness,and more significant traditional Chinese medicine(TCM)symptom improvement than the control group[OR=2.79,95%CI(1.78,4.38),P<0.00001;OR=3.57,95%CI(2.03,6.29),P<0.00001;OR=4.03,95%CI(2.15,7.59),P<0.00001].The experimental group also showed a greater improvement in TCM symptoms[SMD=-0.81,95%CI(-1.39,-0.22),P<0.01]and better controlled laboratory indicators such as white blood cell count[SMD=-0.78,95%CI(-1.10,-0.45),P<0.01],C-reactive protein[SMD=-1.52,95%CI(-2.20,-0.85),P<0.01],procalcitonin[SMD=-1.84,95%CI(-2.85,-0.83),P<0.01],and neutrophils percent[SMD=-0.64,95%CI(-0.97,-0.32),P<0.01].Additionally,the experimental group showed a shorter duration of symptom relief for cough[SMD=-1.59,95%CI(-2.54,-0.64),P<0.01],fever[SMD=-1.09,95%CI(-1.73,-0.44),P<0.01],and lung rales[SMD=-1.94,95%CI(-3.31,-0.57),P<0.01].Conclusions The combined use of lung-clearing and phlegm-resolving method with conventional Western medical treatment can better enhance pneumonia resolution rate,improve clinical effectiveness,improve TCM symptoms,control laboratory test indicators,and shorten the time for symptom relief than the conventional Western medical treatment alone for CAP with phlegm-heat obstructing lung syndrome.However,due to the limited number and quality of studies included,these conclusions require further validation.