麻杏石甘汤联合西药治疗小儿肺炎的系统综述和meta分析

目的：系统评价麻杏石甘汤联合西药治疗小儿肺炎的临床研究。方法：采用Cochrane系统综述方法，检索1994-2008年重庆维普数据库、中文期刊全文数据库、万方数据库和中国生物医学文献数据库等电子资料库，同时手工检索相关杂志、专业资料和网络上的信息。由两名评价者共同评价所纳入研究的质量，对同质研究进行meta分析。采用Cochrane协作网提供的RevMan 4.2.7软件进行meta分析。结果：共检索出146篇文献，符合纳入标准的只有8篇文献，采用Jadad评分标准对纳入研究的每篇文献的方法学质量进行评价。8篇文献均未描述具体的随机方法和分配隐藏的方法，均未提及是否采用盲法，属于低质量文献。Meta分析结果显示麻杏石甘汤联合西药试验组与西药对照组有效率的比值比为4.06，95%可信区间［2.63，6.27］，治疗组有效率优于对照组，差异有统计学意义（P〈0.000 01）。结论：现有临床证据表明，麻杏石甘汤联合西药治疗小儿肺炎较单用西药组有效，可改善患者的临床症状，提高患者的治愈率。但本系统综述纳入的随机对照试验多属低质量文献，进一步证实其临床疗效尚须开展大规模的设计严谨、方法可靠的多中心临床研究以获得更高强度的证据。

Efficacy of Maxing Shigan Decoction combined with Western medicine for pneumonia in children: a systematic review and meta-analysis

Objective： To systematically evaluate the clinical effects of Maxing Shigan Decoction （MXSGD）, a compound traditional Chinese herbal medicine, combined with Western medicine on pneumonia in children.
Methods： In this study, the relative trials published from 1994 to 2008 were searched in Chongqing Weipu Database, Chinese Journal Full-text Database, Wanfang database, Chinese Biomedical Literature Database and other electronic database by using the method of Cochrane systematic review. At the same time the information from related journals, professional data and network were hand-searched. The methodological quality of the included trials was assessed by two evaluators, and homogeneous evaluation by meta-analysis was performed. Statistical analysis of clinical data was performed by using RevMan 4.2.7 software provided by the Cochrane Collaboration.
Results： A total of 146 reports were found, while only eight randomized controlled trials met the inclusion criteria. The methodology quality of the reports included in the study was evaluated by the Jadad scale, and the specific random method, allocation concealment, blinding and intention-to-treat analysis were not described in all of the eight trial reports. As MXSGD combined with Western medicine group （treatment group） was compared with Western medicine group （control group）, the meta-analysis indicated that the odds ratio for the total effective rate was 4.06, and the 95% confidence interval was from 2.63 to 6.27. MXSGD combined with Western medicine was good at increasing the total effective rate as compared with Western medicine, and the difference was statistically significant （P〈0.000 01）.
Conclusion： MXSGD combined with Western medicine can improve clinical symptoms and increase the total effective rate of the patients with pneumonia in children. However, its clinical effects should be further identified by high quality, multicenter and randomized controlled trials with large-scale design.