中药注射液联合西药治疗成人支气管哮喘急性发作期疗效的网状Meta分析＊

目的 对中药注射剂（Chinese medicine injection,CMI）辅助用于成人支气管哮喘（Bronchial asthma,BA）急性发作期治疗的可靠性与有效性展开系统评估。方法 由计算机辅助,对PubMed、中国生物医学文献数据库（China Biology Medicine disc,CBM）、维普（VIP）、中国知网（China National Knowledge Infrastructure,CNKI）、Cochrane Library与万方（WanFang）开展检索,时间区间为建库-2019年3月。搜集6类CMI（“喘可治注射液”“参麦注射液”“痰热清注射液”“细辛脑注射液”“复方丹参注射液”“黄芪注射液”）临床辅助用于成人BA急性发作期治疗相关的随机对照试验（Randomized controlled trials,RCTs）。评估纳入文献的质量,并完成数据提取。借助gemtc与Stata 14实施网状Meta分析,并由RevMan 5.3辅助获得风险偏倚图。结果 围绕18个RCTs与55个半RCTs展开分析,涉及成人BA急性发作期病人总量为6563名。经网状Meta分析发现,①就总有效率而言,相较对照组,6类CMI皆存在显著优势表现;在各CMI间,间接比较参麦以及黄芪这2类注射液,前者表现出显著优势,其余皆未见明显不同表现。②6类CMI辅助治疗成人BA急性发作,根据总有效率的概率排序结果,复方参麦注射液最为显著、依次为丹参注射液、喘可治注射液、细辛脑注射液、痰热清注射液、黄芪注射液。结论 通过既有证据可知,在常规西医治疗BA急性发作期成年病人方面,6类CMI皆能够使疗效增强,参麦注射液效果尤其显著。此外,依然应通过大量设计科学、方法适宜的RCTs来对此项研究所得结论加以验证。

Network Meta-Analysis of the Efficacy of Traditional Chinese Medicine Injection Combined with Western Medicine in Treating Acute Attack of Adult Bronchial Asthma

Objective To systematically evaluate the reliability and effectiveness of traditional Chinese medicine injection (CMI) in the adjuvant treatment of adult bronchial asthma (BA) at the acute onset stage.Methods From the database of PubMed, CBM, VIP, CNKI, Cochrane Library and WanFang, the data of randomized controlled trials (RCTs) were collected, in which six CMIs (Chuankezhi injection, Shenmai injection, Tanreqing injection, Xixinnao injection, Compound Danshen injection and Huangqi injection) were used as the adjuvant treatment against the acute onset of BA in adults. The quality of those retrieved pieces of literature were assessed and the data were then extracted. The reticular Meta-analysis was carried out with GEMTC and Stata14, and the risk bias graph was obtained with the assistance of RevMan 5.3.Results A total of 18 RCTs and 55 semi-RCTs were analyzed, involving 6563 adult patients with acute onset of BA. According to the meta-analysis, in terms of the total effective rate, all the 6 CMIs showed significant advantages compared with the control group. Indirect comparison between Shenmai injection and Huangqi injection showed that the former was superior while the other types showed no obvious difference. According to the probability ranking results of total effective rate of 6 CMIs used as adjuvant treatment against the acute onset of BA in adults, Compound Shenmai injection was the most the superior, followed by Danshen injection, Chuankezhi injection, Xixinnao injection, Tanreqing injection and Huangqi injection.Conclusion Based on the existing evidence, in the conventional western medicine treatment of adult patients with acute onset of BA, the 6 CMIs can improve the curative efficacy, Shenmai injection is the most effective one among others. In addition, the conclusions of this study still need to be verified by a large number of RCTs with scientific design and appropriate methods.