中医药治疗急性发作期支气管哮喘的系统评价

目的：系统评价中医药治疗急性发作期支气管哮喘的疗效与安全性。方法：计算机检索Cochrane图书馆、Medline、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）和中国中医文献检索系统数据库（TCM）,采用Cochraneh and-book进行文献评价,采用Meta分析或描述性分析评价中医药治疗急性发作期支气管哮喘现状。结果：纳入22项随机对照试验,漏斗图明显不对称,提示存在发表偏倚。包括8项中医药与西医药对照的试验和14项中西医结合与西医药对照的试验。合并后,中医药组和中西医结合组疗效均优于西医药对照组（P〈0.00001）[中医药VS西药：P=0.01,RR=1.23,95%CI（1.04,1.44）;中西药联合VS西药：P〈0.00001,RR=1.15,95%CI（1.08,1.23）];2项中西医结合组远期疗效优于对照组（P均〈0.05）;中医药组咳嗽、咳痰疗效优于对照组（P=0.01,P=0.002）,中西医结合组喘息、哮鸣音、咳嗽缓解时间短于对照组（P均〈0.00001）;中医药和中西医结合治疗可以显著提高FEV1（P=0.03）、FVC（P〈0.00001）、FEV1%（P〈0.00001）和PEFR（P=0.002）;中西医结合可以显著降低嗜酸性粒细胞（EOS）（P〈0.00001）、血清IgE（P〈0.00001）;中医药治疗未见不良反应报道。结论：中医药单用或与西医药联合应用治疗急性发作期支气管哮喘有一定的疗效,亦无明显的毒副作用报道。但由于所纳入试验方法学质量低下等原因,其潜在的疗效及安全性还需严格设计的高质量的随机双盲对照试验加以证实。

Systematic Review of Chinese Medicine for Acute Exacerbation of Bronchial Asthma

Objective：To evaluate the efficacy and safety of traditional Chinese medicine（TCM） for acute exacerbation of bronchial asthma.Methods：Randomized control trials（RCTs） were identified from Cochrane Library,CBM,CNKI and TCM.All trials of clinical therapeutic studies on acute exacerbation of bronchial asthma treated by TCM were included and analyzed according to the criteria of the Cochrane Handbook.Revman 5.0 software was used for Meta-analysis.Results：22 RCTs were included,including 8 TCM vs Western medicine（WM） trials,and 14 TCM combining WM vs WM ones.TCM showed more advantages than WM（P〈0.000 01） [TCM vs WM：P = 0.01,RR = 1.23,95% CI（1.04,1.44） ;TCM combining WM vs WM：P〈0.000 01,RR = 1.15,95% CI（1.08,1.23） ].2 TCM combining WM treated trials showed more effectual than western medicine on distant efficiency（P〈0.05 both）.It was also more effective on cough and expectoration（P = 0.01,P = 0.002） in the TCM groups,and release time of dyspnea,cough,wheezing（P〈0.000 01 all） in the combined trials,were shorter than that of WM.TCM could improve the level of FEV1（P = 0.03）,FVC（P〈0.000 01）,FEV1%（P〈0.000 01） and PEFR（P = 0.002）,and decreased levels of eosinophil（EOS）（P〈0.000 01） and IgE（P〈0.000 01）.And TCM did not show much side-effect.Conclusion：TCM or combining with WM is effective acute exacerbation of bronchial asthma,and has fewer disadvantages.However,the reliability of the conclusions were affected because of the methodological quality of the studies included is generally low,and high-quality evidences are needed in order to obtain definite conclusions.