中西医结合治疗结核性胸膜炎的Meta分析
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摘要
【目的】系统评价中西医结合治疗结核性胸膜炎(tuberculous pleurisy)的临床效果以及安全性,为综合治疗结核性胸膜炎提供参考。【方法】计算机检索中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文摘数据库(CBM)、PubMed、the Cochrane library及Embase数据库中中药辨证论治联合抗结核化疗方案(治疗组)vs单用抗结核化疗方案(对照组)治疗结核性胸膜炎的随机对照试验(randomized controlled trials,RCTs)。由两位评价者独立对纳入研究进行筛选和资料提取。采用Cochrane Reviewer’s Handbook推荐的质量评价工具对纳入文献进行质量评价,运用RevMan5.3软件对纳入文献进行Meta分析。【结果】最终纳入14项RCT,共1 400例患者。Meta分析结果显示:与单纯化疗相比,中药辨证论治联合化疗方案可有效提高临床疗效(OR=4.80,95%CI[3.15,7.30],P <0.000 01),减少患者胸膜粘连及增厚(OR=0.22,95%[0.11,0.45],P<0.000 01)。不良反应方面,中药辨证论治联合化疗方案能减少化疗引起的肝功能损害(OR=0.26,95%CI[0.15,0.44],P <0.000 01)及胃肠道反应(0R=0.28,95%CI[0.11,0.67],P=0.005)。【结论】中药辨证论治联合化疗方案治疗结核性胸膜炎能有效提高临床疗效和减少患者胸膜粘连及增厚,减少化疗引起的肝功能损害、消化道反应。但因纳入的RCTs数量和质量有限,本结论仍需大样本、高质量的随机对照试验加以证实。
Objective To systematically investigate the clinical safety and efficacy of integrated traditional Chinese and western medicine in treating tuberculous pleurisy(TBP),thus to provide evidence for clinical treatment of TBP. Methods We collected randomized controlled trials(RCTs)of Chinese medicine therapy based on syndrome differentiation plus antitubercular agents(treatment group)vs antitubercular agents alone(control group)in treating TBP from CNKI,Wanfang database,VIP database,Chinese Biological and Medical Database(CBM),PubMed,the Cochrance library,and Embase by computer retrieval. The screening of RCTs and the data extract were performed by two researchers independently. The quality of the included trials was evaluated with the Cochrane Reviewer's Handbook for systematic reviews,and RevMan 5.3 software was adopted to perform Metaanalysis. Results A total of 14 RCTs involving 1 400 patients were enrolled into the analysis. The Meta-analysis results showed that compared with the treatment of TBP by antitubercular agents alone,Chinese medicine therapy based on syndrome differentiation plus antitubercular agents could enhance the clinical efficacy(OR = 4.80,95%CI[3.15,7.30],P < 0.000 01)and reduce pleural adhesion and thickening(OR = 0.22,95%[0.11,0.45],P<0.000 01)in treating TBP; in respect of the adverse reaction, Chinese medicine therapy based on syndrome differentiation plus antitubercular agents could alleviate the damage of liver function(OR = 0.26,95%CI[0.15,0.44], P < 0.000 01)and gastrointestinal reaction(OR = 0.28, 95%CI[0.11, 0.67], P = 0.005)caused by antitubercular agents. Conclusion Chinese medicine therapy based on syndrome differentiation plus antitubercular agents can effectively enhance the clinical efficacy,reduce pleural adhesion and thickening,and alleviate the damage of liver function and gastrointestinal reaction caused by antitubercular agents. However,due to the small quantity and low quality of the included RCTs,the above conclusion still need to be further verified with large sample and high quality RCTs.
Objective To systematically investigate the clinical safety and efficacy of integrated traditional Chinese and western medicine in treating tuberculous pleurisy(TBP),thus to provide evidence for clinical treatment of TBP. Methods We collected randomized controlled trials(RCTs)of Chinese medicine therapy based on syndrome differentiation plus antitubercular agents(treatment group)vs antitubercular agents alone(control group)in treating TBP from CNKI,Wanfang database,VIP database,Chinese Biological and Medical Database(CBM),PubMed,the Cochrance library,and Embase by computer retrieval. The screening of RCTs and the data extract were performed by two researchers independently. The quality of the included trials was evaluated with the Cochrane Reviewer's Handbook for systematic reviews,and RevMan 5.3 software was adopted to perform Metaanalysis. Results A total of 14 RCTs involving 1 400 patients were enrolled into the analysis. The Meta-analysis results showed that compared with the treatment of TBP by antitubercular agents alone,Chinese medicine therapy based on syndrome differentiation plus antitubercular agents could enhance the clinical efficacy(OR = 4.80,95%CI[3.15,7.30],P < 0.000 01)and reduce pleural adhesion and thickening(OR = 0.22,95%[0.11,0.45],P<0.000 01)in treating TBP; in respect of the adverse reaction, Chinese medicine therapy based on syndrome differentiation plus antitubercular agents could alleviate the damage of liver function(OR = 0.26,95%CI[0.15,0.44], P < 0.000 01)and gastrointestinal reaction(OR = 0.28, 95%CI[0.11, 0.67], P = 0.005)caused by antitubercular agents. Conclusion Chinese medicine therapy based on syndrome differentiation plus antitubercular agents can effectively enhance the clinical efficacy,reduce pleural adhesion and thickening,and alleviate the damage of liver function and gastrointestinal reaction caused by antitubercular agents. However,due to the small quantity and low quality of the included RCTs,the above conclusion still need to be further verified with large sample and high quality RCTs.
引文
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[11]赵芳敏,梁庆佳,钟丽萍,等.中西医结合治疗结核性胸膜炎30例临床观察[J].中国民族民间医药,2016,25(18):97.
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[13]周孝清,邱秀芹,刘天明.中西医结合治疗结核性胸膜炎临床观察[J].实用中医药杂志,2017,33(4):385.
[14]孙世长.中药治疗结核性渗出性胸膜炎96例[J].中国中医药现代远程教育,2017,15(1):52.
[15]卢利员,黄斌,漆冬梅.逐饮活血方辅助治疗结核性胸膜炎疗效观察[J].中国中医药信息杂志,2012,19(12):75.
[16]张志杰,曹培谦.中西医结合治疗结核性胸膜炎胸膜增厚临床研究[J].中医学报,2017,32(8):1547.
[17]郭世钊,张琦,张明勇.自拟逐饮活血汤辅助治疗结核性胸膜炎的疗效及对炎症因子与肺功能的影响[J].现代中西医结合杂志,2016,25(30):3333.
[18]谢清,王娇娇.尿激酶胸腔内注射治疗结核性胸膜炎的临床观察与护理[J].中国实用医药,2014,9(28):202.
[19]汪夙兴,欧阳海峰.尿激酶、地塞米松预防及治疗结核性胸膜炎胸膜肥厚和胸膜粘连的研究[J].实用临床医学,2013,14(2):33.
[2]中华人民共和国卫生部.肺结核门诊诊疗规范(2012年版)[J].中国医学前沿杂志(电子版),2013,5(3):73.
[3]WHO.WHO Handbook for reporting results of cancer treatment[M].Geneva,Switzerland:World Health Organization,1979.
[4]史秀莲,乔军.健脾益气活血化瘀药辅助治疗渗出性胸膜炎的疗效观察[J].内科急危重症杂志,2006,12(1):29.
[5]熊应权,黄淑萍.结核性胸膜炎的中药辅助治疗观察[J].天津药学,2009,21(3):53.
[6]何珂,陈燕明.结核性胸膜炎患者的辨证施治[J].世界中医药,2013,8(10):1181.
[7]闫宝环,董玉霞,赵莲萍,等.温阳化湿利水法治疗结核性渗出性胸膜炎研究[J].中国中医基础医学杂志,2013,19(3):299.
[8]熊友乐.中西结合治疗结核性胸膜炎的临床报道[J].中外医学研究,2011,9(34):72.
[9]王洪元,白静,金德华.中西医结合治疗结核性渗出性胸膜炎疗效观察[J].现代中西医结合杂志,2014,23(27):2993.
[10]杨正志,孙延康.中西医结合治疗结核性渗出性胸膜炎36例疗效观察[J].世界中西医结合杂志,2009,4(1):41.
[11]赵芳敏,梁庆佳,钟丽萍,等.中西医结合治疗结核性胸膜炎30例临床观察[J].中国民族民间医药,2016,25(18):97.
[12]陈炳忠,潘向荣,黄贵熙.中西医结合治疗结核性胸膜炎46例疗效观察[J].四川中医,2004,22(10):34.
[13]周孝清,邱秀芹,刘天明.中西医结合治疗结核性胸膜炎临床观察[J].实用中医药杂志,2017,33(4):385.
[14]孙世长.中药治疗结核性渗出性胸膜炎96例[J].中国中医药现代远程教育,2017,15(1):52.
[15]卢利员,黄斌,漆冬梅.逐饮活血方辅助治疗结核性胸膜炎疗效观察[J].中国中医药信息杂志,2012,19(12):75.
[16]张志杰,曹培谦.中西医结合治疗结核性胸膜炎胸膜增厚临床研究[J].中医学报,2017,32(8):1547.
[17]郭世钊,张琦,张明勇.自拟逐饮活血汤辅助治疗结核性胸膜炎的疗效及对炎症因子与肺功能的影响[J].现代中西医结合杂志,2016,25(30):3333.
[18]谢清,王娇娇.尿激酶胸腔内注射治疗结核性胸膜炎的临床观察与护理[J].中国实用医药,2014,9(28):202.
[19]汪夙兴,欧阳海峰.尿激酶、地塞米松预防及治疗结核性胸膜炎胸膜肥厚和胸膜粘连的研究[J].实用临床医学,2013,14(2):33.
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