摘要
目的:评价清肺化痰法治疗慢性阻塞性肺疾病(COPD)急性加重期的疗效及安全性,为其COPD急性加重期的治疗提供依据。方法:计算机检索美国国立医学图书馆(PubMed)、EMBase、Cochrane Library、中国期刊网(CNKI)、万方数据库(Wanfang)、中国科技期刊全文数据库(VIP)等文献数据库,全面收集2018年6月之前,以清肺化痰方药单用、或联合常规西药治疗为观察组、常规西药治疗为对照组治疗COPD急性加重期的临床随机对照试验(RCT)。文献质量评价采用Cochrane协作网的偏倚风险评价工具进行评价,由两位评价者独立评价和资料提取后采用RevMan5.3软件对主要结局指标包括临床总有效率,次要结局指标包括肺功能(FVC、FEV1、FEV1%、FEV1/FVC)、血气分析(PaO2、PaCo2)等进行Meta分析。结果:本文究共13篇文献,共纳入990例患者,其中观察组496例,对照组494例,均有报道结局指标。Meta分析结果提示,清肺化痰法联合西医常规治疗与单纯西医常规治疗比较能显著提高有效率,肺功能(FVC、FEV1、FEV1%、FEV1/FVC)、血气分析(PaO2、PaCo2)等结局指标与对照组比较改善明显,差异有统计学意义(P<0.00001)。但是,所纳入的研究因观察期较短,未报告观察组辅助中药治疗的不良反应。结论:清肺化痰法可以提高COPD急性加重期患者治疗的有效率,辅助改善肺功能及血气分析等指标、提高患者的生命质量,但现有研究质量偏低,多未较好的设盲及实施盲法,也没有实施隐蔽分组,所以确切的结论仍需开展更高质量的RCT加以验证。
Objective: To evaluate the efficacy and safety of the lung-clearing and phlegm-dissolving method in the treatment of acute exacerbation of Chronic Obstructive Pulmonary Disease(COPD),and to provide a basis for the treatment of acute exacerbation of COPD. Methods: Computer retrieval was conducted on the National Library of Medicine(PubMed),EMBase,Cochrane Library,Chinese Journal Network(CNKI),Wanfang database(Wanfang),and the full text database of Chinese sci-tech periodicals(VIP),etc.A comprehensive collection of clinical Randomized Controlled Trials(RCTs),conducted before June 2018,of acute exacerbation of COPD with TCM prescriptions using the lung-clearing and phlegm-dissolving method,used alone or used in combination with conventional Western medicine as the experiment group with conventional Western medicine being the control group,was collected.The literature quality evaluation was performed via the bias risk assessment tool of the Cochrane Collaboration.After the independent evaluation and data extraction of two evaluators,Meta-analysis was performed on the main outcome indicators,including the clinical total efficiency,and the secondary outcome indicators,including pulmonary function(FVC,FEV1,FEV1%,FEV1/FVC)and blood gas analysis(PaO 2,PaCo 2),etc.via RevMan 5.3 software. Results: In the total of 13 documents and 990 patients,496 cases in the treatment group and 494 in the control group,were included in this study with reported outcome indicators.The results of Meta-analysis showed that the efficacy of the lung-clearing and phlegm-dissolving method combined with conventional treatment of Western medicine was significantly higher than that of conventional Western medicine.The outcome indicators of lung function(FVC,FEV1,FEV1%,FEV1/FVC)and blood gas analysis(PaO 2,PaCo 2)were significantly improved compared with the control group,and the difference was statistically significant( P <0.000 01).However,due to the relatively short observation period of the included studies,adverse reactions of the Chinese medicine in the treatment groups were not reported. Conclusion: The lung-clearing and phlegm-dissolving method can improve the efficiency of the treatment of acute exacerbation of COPD,assist in improving the indicators of lung function and blood gas analysis,and better the quality of life of the patients.However,the quality of existing researches is relatively low,and the blinding is unsatisfactory and the blind method is poorly implemented,without covert grouping,so definite conclusions still await future RCTs of higher quality to be tested.
作者
张涛
刘改霞
李耀辉
唐秀林
Zhang Tao;Liu Gaixia;Li Yaohui;Tang Xiulin(Shaanxi University of Chinese medicine,Xianyang 712046,China;Shaanxi Traditional Chinese Medicine Hospital,Xi′an 710000,China)
出处
《世界中医药》
CAS
2019年第5期1181-1187,共7页
World Chinese Medicine
基金
中医药行业科研专项(201507001-01)
关键词
清肺化痰法
慢性阻塞性肺疾病
急性加重期期
系统评价
META分析
Lung-clearing and phlegm-dissolving
Chronic obstructive pulmonary disease
Acute exacerbation stage
Systematic review
Meta-analysis
