中药注射液治疗慢性阻塞性肺疾病急性加重期的网状Meta分析

目的采用网状Meta分析方法评价中药注射液治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效。方法计算机检索常用7大中英文数据库,收集中药注射液与西医常规疗法对照,或不同中药注射液治疗AECOPD的随机对照试验,检索时间从建库至2019年3月15日。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险,采用Stata/SE 14.0软件对数据进行分析。结果共纳入21项RCT,包括1879例AECOPD患者,共8种常用中药注射液。网状Meta分析结果显示:在西医常规治疗的基础上联合血必净MD=0.36,95%CI(0.15,0.57)]、痰热清MD=0.30,95%CI(0.13,0.47)]、清开灵MD=0.23,95%CI(0.01,0.45)]、喘可治MD=0.21,95%CI(0.01,0.42)]比喜炎平更有效提高FEV1;在西医常规治疗的基础上联合血必净MD=0.39,95%CI(0.22,0.55)]、痰热清MD=0.33,95%CI(0.26,0.40)]、鱼腥草MD=0.37,95%CI(0.01,0.73)]、清开灵MD=0.25,95%CI(0.12,0.39)]、热毒宁MD=0.24,95%CI(0.05,0.43)]、喘可治MD=0.24,95%CI(0.13,0.35)]、细辛脑MD=0.20,95%CI(0.04,0.36)]比单纯西医常规治疗更有效提高FEV1;根据SUCRA值的累积概率排序显示,改善肺功能FEV1的疗效排序为:血必净>痰热清>鱼腥草>清开灵>热毒宁>喘可治>细辛脑>喜炎平。结论提高FEV1血必净疗效最佳,其次是痰热清,同时建议临床医师结合具体实际谨慎运用本研究结论,注意根据辨证论治的原则选择中药注射液。

Network Meta-analysis of Chinese Herbal Injections in Treatment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective To assess the effectiveness of Chines herbal injections in treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)using network Meta-analysis.Methods Databases including the 7 databases were searched for relevant clinical randomized controlled trials(RCTs)comparing Chines herbal injections with western treatment or different kinds of Chines herbal injections from the inception to March 15,2019.The literature screening,data extraction and the risk of bias assessment of included studies assessed were all conducted independently by two reviewers.Then the Meta-analysis was performed by Stata/SE 14.0.Results A total of 21 RCTs involving 1879 AECOPD patients and 8 kinds of Chines herbal injections were included.The results of network Meta-analysis showed that based on conventional western medicine treatment,Xuebijing Injection(血必净注射液)MD=0.36,95%CI(0.15,0.57)],Tanreqing Injection(痰热清注射液)MD=0.30,95%CI(0.13,0.47)],Qingkailing Injection(清开灵注射液)MD=0.23,95%CI(0.01,0.45)],Chuankezhi Injection(喘可治注射液)MD=0.21,95%CI(0.01,0.42)]were more effective than Xiyanping Injection(喜炎平注射液)in improving FEV1 the combinations of Xuebijing InjectionMD=0.39,95%CI(0.22,0.55)],Tanreqing InjectionMD=0.33,95%CI(0.26,0.40)],Yuxingcao Injection(鱼腥草注射液)MD=0.37,95%CI(0.01,0.73)],Qingkailing InjectionMD=0.25,95%CI(0.12,0.39)],Reduning Injection(热毒宁注射液)MD=0.24,95%CI(0.05,0.43)],Chuankezhi InjectionMD=0.24,95%CI(0.13,0.35)]and Xixinnao Injection(细辛脑注射液)MD=0.20,95%CI(0.04,0.36)]when treating AECOPD,improved the forced expiratory volume in one second(FEV1)of the pulmonary function.According to the cumulative probability ranking of the SUCRA values,the ranking of the efficacy of improving the pulmonary function FEV1 was Xuebijing Injection,Tanreqing Injection,Yuxingcao Injection,Qingkailing Injection,Reduning Injection,Chuankezhi Injection,Xixinnao Injection,Xiyanping Injection.Conclusion Xuebijing Injection is the best in improving the FEV1 and the second one is Tanreqing Injection.It is suggested that the clinical situation and TCM syndrome differentiation should be considered when selecting Chines herbal injections.