Clinical efficacy and safety of Chinese herbal medicine versus placebo for the treatment of chronic obstructive pulmonary disease: A systematic review and meta-analysis

ObjectiveRandomized clinical trials and published meta-analyses assessing the clinical effectiveness of Chinese herbal medicine (CHM) on the treatment of stable chronic obstructive pulmonary disease (COPD) yielded inconsistent results in terms of disease outcomes, in which the design of placebo-controlled studies can contribute to the heterogeneity. This study aimed to evaluate the efficacy and safety of CHM compared to placebo on the treatment of stable COPD, to provide robust evidence for the use of CHM in COPD.MethodsNine electronic databases were searched from inception to October 1, 2019 to identify placebo controlled randomized trials of CHM for the treatment of stable COPD and studies in English or Chinese were included. The primary outcomes were symptom score (CAT score), quality of life (SGRQ) and frequency of acute exacerbations. The secondary outcomes included lung function, clinical total effective rate and adverse events. The selection of studies, data extraction and coding and assessment of risk of bias of the included studies were conducted by two reviewers independently. Mean difference (MD) was used to analyze continuous variable and relative risk ratio (RR) for dichotomous data.ResultsA total of eleven studies involving 1223 patients were included. While maintaining routine western pharmacotherapies (WP), CHM had significant advantage over the treatment of placebo in improving CAT score (MD -3.93; 95 %CI -6.01 to -1.85) and SGRQ score (MD -6.20; 95 %CI -10.13 to -2.28), reducing the frequency of acute exacerbations (MD -0.78; 95 %CI -1.40 to -0.16) and improving clinical effective rate (RR 1.29; 95 %CI 1.14 to 1.45), but had no significant effect on improving FEV₁%pred (MD 8.18; 95 %CI -4.22 to 20.58). High heterogeneity was found for the changes in exacerbation frequency and FEV₁%pred. No serious adverse events related to CHM were reported.ConclusionsThis meta-analysis of placebo-controlled RCTs demonstrated that the use of CHM in addition to WP could alleviate clinical symptoms, improve quality of life and clinical efficiency and reduce the frequency of exacerbations, which could be an alternative approach for treatment adjustment of COPD. CHM was a relatively safe treatment. These findings need to be verified in future with high-quality clinical trials.     

血清肿瘤标志物的参考变化值和参考变化因子应用比较研究

目的 探讨常规肿瘤标志物参考变化值(RCV)和参考变化因子(RCF)单向、双向分别在不同概率下(P<0.05,P<0.01)的应用比较研究。方法 根据参考变化值(RCV)及参考变化因子(RCF)公式计算常规肿瘤标志物在不同概率下的数值。结果 常规肿瘤标志物的RCV(单向,双向在P<0.05时)分别为AFP(30.99%,36.81%),CEA(30.48%,36.21%),CA125(64.30%,76.39%),CA153(15.68%,18.62%),CA199(40.60%,48.23%)和tPSA(43.19%,51.30%)。RCV(单向,双向在P<0.01时)分别为AFP(43.76%,48.45%),CEA(43.05%,47.67%),CA125(90.81%,100.55% ), CA153(22.14%,24.52%),CA199(57.33%,63.48%)和tPSA(60.99%,67.53%)。RCF(单向,双向在P<0.05时)RCF_UP-DOWN分别为AFP(1.36%,0.74%,1.44%,0.69%),CEA(1.36%,0.74%,1.44%,0.69%),CA125(1.90%,0.53%,2.15%,0.47%),CA153(1.17%,0.85%,1.2%,0.83%),CA199(1.50%,0.67%,1.62%,0.62%)和tPSA(1.54%,0.65%,1.67%,0.60%)。RCF(单向,双向在P<0.01)RCF_UP-DOWN分别为AFP(1.55%,0.65%,1.62%,0.62%),CEA(1.54%,0.65%,1.61%,0.62%),CA125(2.48%,0.40%,2.73%,0.37%),CA153(1.25%,0.80%,1.28%,0.78%),CA199(1.77%,0.56%,1.89%,0.53%)和tPSA(1.84%,0.54%,1.96%,0.51%)。结论 在相同概率下,双侧RCV值高于单侧,而RCF值变化不大。参考变化值RCV仅适用两次检测结果之间的分析,在多于两个连续检测结果时应使用RCF,当RCF作为临床决策工具时可对首诊病人做出正面和负面的预测值,为临床诊断提供科学依据。     

电针结合耳穴贴压对围绝经期失眠患者睡眠及生活质量的影响

目的观察电针结合耳穴贴压对围绝经期失眠患者睡眠及生活质量的影响。方法将60例围绝经期失眠患者随机分为治疗组和对照组,每组30例。对照组采用口服艾司唑仑治疗,治疗组采用电针结合耳穴贴压治疗。两组疗程均为28 d,观察临床疗效,比较匹兹堡睡眠质量指数(PSQI)评分及围绝经期生存质量量表(MENQOL)评分的变化情况,同时进行安全性评价。结果①治疗组、对照组总有效率分别为93.3%、73.3%;两组临床疗效比较,治疗组明显优于对照组(P<0.05)。②治疗前后组内比较,治疗组PSQI中各维度评分及总分均减少(P<0.05),对照组入睡时间、睡眠时间、睡眠效率评分及总分减少(P<0.05);组间治疗后比较,治疗组睡眠质量、睡眠障碍、日间功能评分及总分少于对照组(P<0.05)。③治疗前后组内比较,两组MENQOL评分减少(P<0.05);组间治疗后比较,治疗组MENQOL评分少于对照组(P<0.05)。④两组均未见明显的不良反应。结论电针结合耳穴贴压治疗围绝经期失眠疗效满意,能有效改善患者的睡眠质量和生活质量,且安全性好,值得临床推广应用。     

藏药兔耳草常用基原的ITS2序列鉴定研究

目的 利用DNA条形码内转录间隔区2（internal transcribed spacer 2,ITS2）序列针对自采及流通使用环节的不同基原兔耳草进行分析,建立一种快速鉴定常用兔耳草的方法,并分析市场流通的主流品种。方法 采用试剂盒提取101份兔耳草样品的DNA,针对其ITS2片段进行PCR扩增并双向测序,获取ITS2序列信息;并从GenBank上下载相关序列28条。运用MEGA6.0对129条ITS2序列进行比对分析,计算种内和种间K2P遗传距离,构建邻接法（neighbor-joining,NJ）系统进化树,并预测ITS2二级结构。采用BLAST法及NJ聚类分析法分析市场流通兔耳草基原。结果 除四川部分区域所产全缘兔耳草Lagotis integra与革叶兔耳草L.alutacea种间亲缘关系近外,短筒兔耳草L.brevituba、全缘兔耳草、圆穗兔耳草L.ramalana、革叶兔耳草、短穗兔耳草L.brachystachya及紫叶兔耳草L.praecox的种内最大遗传距离均小于种间最小遗传距离,具有明显的条形码间距。系统进化树显示短筒兔耳草、圆穗兔耳草、短穗兔耳草及紫叶兔耳草单独聚为一支,四川部分区域所产全缘兔耳草与革叶兔耳草聚为一支,其余全缘兔耳草聚为一支。通过ITS2二级结构发现,各基原兔耳草在茎环数目、大小及位置均有一定差异,可区分亲缘关系近的全缘兔耳草与革叶兔耳草。市场分析显示,市面上流通的兔耳草有6种基原,以全缘兔耳草使用占比最高,短筒兔耳草次之,短穗兔耳草及圆穗兔耳草较低,紫叶兔耳草及革叶兔耳草最低。结论 ITS2序列可以作为DNA条形码用来鉴别常用藏药兔耳草的基原,市场主流兔耳草品种为全缘兔耳草、短筒兔耳草及短穗兔耳草。     

电针结合耳穴贴压对围绝经期失眠患者睡眠及生活质量的影响

目的观察电针结合耳穴贴压对围绝经期失眠患者睡眠及生活质量的影响。方法将60例围绝经期失眠患者随机分为治疗组和对照组,每组30例。对照组采用口服艾司唑仑治疗,治疗组采用电针结合耳穴贴压治疗。两组疗程均为28 d,观察临床疗效,比较匹兹堡睡眠质量指数(PSQI)评分及围绝经期生存质量量表(MENQOL)评分的变化情况,同时进行安全性评价。结果①治疗组、对照组总有效率分别为93.3%、73.3%;两组临床疗效比较,治疗组明显优于对照组(P0.05)。②治疗前后组内比较,治疗组PSQI中各维度评分及总分均减少(P0.05),对照组入睡时间、睡眠时间、睡眠效率评分及总分减少(P0.05);组间治疗后比较,治疗组睡眠质量、睡眠障碍、日间功能评分及总分少于对照组(P0.05)。③治疗前后组内比较,两组MENQOL评分减少(P0.05);组间治疗后比较,治疗组MENQOL评分少于对照组(P0.05)。④两组均未见明显的不良反应。结论电针结合耳穴贴压治疗围绝经期失眠疗效满意,能有效改善患者的睡眠质量和生活质量,且安全性好,值得临床推广应用。