中西医结合治疗SARS疗效的系统评价

目的评价中西医结合疗法的疗效.方法检索策略:电子检索MEDLINE,EMBASE,和中国生物医学资料库;手工检索中文杂志和已发表相关文献的参考文献目录、INTERNET、会议论文集.资料的收集与分析:三个评价者独立地收集提取资料.对具有同质性的资料进行Meta-分析.纳入研究:中西医结合治疗SARS并与西医进行对照的随机对照试验和前瞻性对照研究.观察对象:根据中国卫生部、世界卫生组织、美国疾病控制中心的SARS诊断标准确诊的SARS患者.干预措施:治疗组采用中西医结合治疗,对照组单用西医治疗.主要测量指标:①病死率;②由于使用激素引起的并发症发生率;③SARS病毒消除率,采用细胞培养和PCR检测;④退热时间;⑤胸片显示肺部炎症吸收时间和完全吸收例数;⑥下呼吸道感染症状消失时间(咳嗽、呼咳困难、呼咳短促等).次要测量指标:①激素累积剂量或平均使用时间;②T-淋巴细胞亚群计数(CD3 ,CD4 ,CD5 ,CD8 ).结果纳入9个研究,包括812例患者,所有9个研究都存在选择性偏倚、实施性偏倚、检测性偏倚的高可能性.以下指标中西医结合治疗与单纯西医治疗的差异有统计学意义,并优于单纯西医治疗:病死率OR 0.32,95%CI(0.14,0.71)],退热时间WMD-1.17,95%CI(-1.83,-0.50)],症状缓解时间WMD-1.47,95%CI(-1.96,-0 98)],和肺部炎症完全吸收例数WMD 1 63,95%CI(0 95,2.80)].以下指标中西医结合治疗与单纯西医治疗的差异无统计学意义:恢复期患者症状积分WMD-1.25,95%CI(-2 71,0.21)],糖皮质激素累积剂量WMD-236.96,95%CI(-490.64,16.73)]和肺部炎症吸收平均时间WMD 0.63,95%CI(-1.33,2.59)],两者疗效相同.其中,将病死率指标中纳入的一个大权重、两组危重病人数分布不均的非随机对照试验排除后做敏感性分析,则两组病死率的差异无统计学意义OR 0.53,95%CI(0.20,1 41)].结论中西医结合治疗SARS在多数指标上显示了优于单纯西医治疗的趋势;但由于纳入研究方法学上的局限性,对于中西医结合治疗SARS的疗效优于单纯西医治疗的结论尚需更多高质量的研究予以支持.

A Systematic Review of Assessing the Effect of Integrated Traditional Chinese Medicine with Western Medicine for Severe Acute Respiratory Syndrome

Objective To assess the effect of integrated traditional Chinese medicine with western medicine (ICWM) in the treatment of SARS. Methods We searched MEDLINE,EMBASE,and Chinese BioMed Database (CBM),and the Internet performed handsearching in Chinese journals and reference lists. We included randomised controlled trials and prospective controlled studies of integrated Chinese medicine with western medicine versus western medicine alone in people with SARS. Three independent reviewers collected details of study population,interventions,and outcomes using a data extraction form. We conducted meta-analysis for similar data of studies. Results Nine studies (n=812) were included,all with the possibility of containing serious bias. ICWM in the treatment of SARS was associated with the following reductions: case fatality \OR 0.32,95%CI (0.14,0.71)\],fever clearance time \WMD -1.17,95%CI (-1.83,-0.50),symptom remission time \WMD -1.47,95%CI (-1.96,-0.98)\] and the number of inflammation absorption cases \WMD 1.63,95%CI (0.95,2.80)\],having no significant difference in symptom scores of convalescents \WMD -1.25,95%CI (-2.71,0.21)\],cumulative dose of corticosteroids \WMD -236.96,95%CI (-490.64,16.73)\] and inflammation absorption mean time \WMD 0.63,95%CI (-1.33, 2.59)\]. Conclusions Due to the methodological limitations of the studies,the effect of ICWM for SARS is unclear. The apparent improvements in cases fatality,fever clearance time,syndromes remission time and numbers of inflammation absorption cases warrant further evaluation with high quality and large scale trials to be expected.