4种常用中成药辅助治疗小儿急性上呼吸道感染的网状Meta分析

目的:通过网状Meta分析方法,评价儿童常用口服中成药联合常规西药治疗小儿急性上呼吸道感染的疗效及安全性。方法:选取治疗小儿急性上呼吸道感染常用的中成药,即馥感啉口服液、小儿柴桂退热颗粒(口服液)、小儿豉翘清热颗粒和小儿双清颗粒。通过计算机检索中国知网、万方数据库、维普数据库及PubMed、Web of Science数据库,搜索上述4种中成药联合常规西药对比单独服用常规西药治疗小儿急性上呼吸道感染的随机对照试验,检索时限为数据库建立至2021年8月16日。筛选文献、提取数据和评价质量后,采用RevMan 5.3、R 4.0.3和Stata 15.1软件进行统计分析。结果:最终纳入26篇文献,网状Meta分析结果显示,(1)上述4种中成药辅助治疗小儿急性上呼吸道感染的临床总有效率均优于常规西药单独治疗,差异具有统计学意义(P<0.05),与直接Meta分析结果一致;根据等级概率图排序得出,馥感啉口服液+西药的临床总有效率最优,其次依次为小儿双清颗粒+西药、小儿豉翘清热颗粒+西药和小儿柴桂退热颗粒(口服液)+西药,上述4种中成药与西药联合应用的临床总有效率相互比较,差异无统计学意义(P>0.05)。(2)小儿豉翘清热颗粒的不良反应发生率略低于小儿柴桂退热颗粒(口服液),二者差别不大;馥感啉口服液和小儿双清颗粒的纳入文献中无明显不良反应的报道。结论:以常规西药为基础,分别联合使用4种中成药治疗小儿急性上呼吸道感染均能使疗效显著提高,其中馥感啉口服液与西药联合治疗的效果显著。但基于现有文献的质量和研究的局限性,本研究结论还需更多高质量的临床研究进行验证。

Network Meta-Analysis of Four Commonly Used Chinese Patent Medicines in Adjuvant Treatment of Acute Upper Respiratory Infection in Children

OBJECTIVE: To evaluate the efficacy and safety of four commonly used Chinese patent medicines in adjuvant treatment of acute upper respiratory infection in children through network Meta-analysis. METHODS: Four kinds of Chinese patent medicines in the treatment of acute upper respiratory infection were selected,including Fuganlin oral liquid,Xiao’er Chaigui Tuire granules( oral liquid),Xiao’er Chiqiao Qingre granules and Xiao’er Shuangqing granules. CNKI,Wanfang Data,VIP,PubMed and Web of Science were retrieved to collect randomized controlled trials of the four kinds of Chinese patent medicines combined with conventional western medicines in the treatment of acute upper respiratory infection in children. The retrieval time was from the establishment of the database to Aug. 16 th,2021. After literature screening,data extraction and quality evaluation,RevMan 5. 3,R 4. 0. 3 and Stata15. 1 software were used for statistical analysis. RESULTS: Totally 26 articles were included.( 1) The total clinical effective rates of four kinds of Chinese patent medicines in adjuvant treatment of acute upper respiratory infection in children were better than those of conventional western medicines alone,the differences were statistically significant( P<0. 05),which were consistent with the results of direct Meta-analysis. According to the grade probability diagram,the total clinical effective rate of Fuganlin oral liquid combined with western medicines was the highest,followed by Xiao’er Shuangqing granules combined with western medicines,Xiao’er Chiqiao Qingre granules combined with western medicines,Xiao’er Chaigui Tuire granules( oral liquid) combined with western medicines. There was no significant difference in the total clinical effective rates of four kinds of Chinese patent medicines combined with western medicines( P>0. 05).( 2) The incidence of adverse drug reactions of Xiao’er Chiqiao Qingre granules was slightly lower than that of Xiao’er Chaigui Tuire granules( oral liquid),with no statistically significant difference. No adverse drug reactions of Fuganlin oral liquid and Xiao’er Shuangqing granules were reported in the included literature. CONCLUSIONS: Four kinds of Chinese patent medicines combined with western medicines in the treatment of acute upper respiratory infection in children can significantly increase the curative efficacy,and the therapeutic efficacy of Fuganlin oral liquid combined with western medicines is significant. However,based on the quality of existing literature and limitations of the study,the conclusions need to be validated by more high-quality clinical studies.