中西医结合治疗SARS的系统评价与Meta-分析

目的评价中西医结合治疗严重急性呼吸综合征（SARS）的疗效。方法作者检索了Cochrane图书馆、PubMed、中国生物医学文献数据库、中文期刊全文数据库、中国科技文献数据库、Cochrane协作网补充医学领域试验数据库和AMED截至2004年4月．纳入所有中西医结合治疗SARS与单用西医治疗比较的随机对照试验。根据随机分配方法、随机方案隐藏、盲法和意向治疗分析评价纳入研究的质量。对非随机的临床对照研宄进行探索性分析。两名作者独立提取资料、评价质量及结局。用Meta-分析方法对资料进行定量综合。结果共纳入8篇中西医结合与西医比较治疗共计488例SARS患者的随机对照试验。试验的方法学质量普遍较低。Meta-分析表明：中西医结合疗法显著降低患者的病死率（相对获益系数RR0．32；95％可信区间0．12～0．91），并减少激素治疗SARS患者发生真菌感染（0．35；0．14～0．90）的可能性：同时，中西医结合疗法缩短发热的时间[权重均数差-0．83（天）；-1．30～-0．35]、症状缓解时间（-1．23；-2．09～-0．37]）以及胸部X线异常的持续时间（-2．61；-3．74～-1．49）。对生活质量或激素用量差异无显著性。试验未报道中西医结合治疗的不良反应。结论中西医结合治疗SARS具有降低病死率、减少继发真菌感染、缩短症状及发热时间、减轻肺部炎症的效果。但由于试验的质量较低，现有的证据还不足以得出肯定的结论。

Systematic Review and Meta-analysis on the Integrative Traditional Chinese and Western Medicine in Treating SARS

OBJECTIVE: To systematically evaluate the effects of Chinese herbal medicine in treating severe acute respiratory syndrome (SARS). METHODS: Electronic and manual searches was conducted to identify randomised controlled trials (RCTs) for comparing the effects of integrative traditional Chinese and Western medicine versus the effects of Western medicine alone in treating SARS. Methodological quality of trials was assessed in terms of generation of allocation sequence, allocation concealment, blinding, and intention-to-treat. Exploring analysis was carried out on the non-randomized clinical controlled studies. Two authors collected data independently and evaluated quality and results. The data were quantified by Meta-analysis. RESULTS: Eight RCTs (488 SARS patients) were included. The methodological quality was generally low. Results of Meta-analysis showed that the integrative therapy could significantly reduce the mortality (relative risk 0.32 [95% CI 0.12 - 0.91]) and the occurrence of fungal infection in patients who received hormone (glucocorticoid) therapy (0.35: 0.14 - 0.90), shorten the duration of fever (weighted mean difference -0.83 day; -1.30 - -0.35) and symptom relieving time (-1.23; -2.09 - -0.37), reduce the persistent time of chest radiograph abnormalities (- 2.61; -3.74 - -1.49). But it showed no significant difference on quality of life or glucocorticoid dosage. Conclusion The integrative therapy may have beneficial effects in lowering mortality, reducing complications, shortening the duration of symptoms and fever existence and lessening pulmonary inflammation in SARS patients. The evidence is insufficient to come to the affirmative conclusion due to the low methodological quality of the included trials.