养阴清肺汤治疗慢性咳嗽和慢性阻塞性肺疾病疗效和安全性的Meta分析
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摘要
目的系统评价养阴清肺汤治疗慢性咳嗽和慢性阻塞性肺疾病的有效性和安全性。方法计算机检索Pub Med、Web of Science、CBM、CNKI、VIP和Wan Fang Data数据库,搜集养阴清肺汤治疗慢性咳嗽和慢性阻塞性肺疾病的随机对照试验(RCT),检索时限均为建库至2016年8月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入24个RCT,包括2 268例患者。Meta分析结果显示:与对照组相比,养阴清肺汤联合常规治疗能提高治疗慢性阻塞性肺疾病的临床疗效[RR=1.21,95%CI(1.16,1.27),P<0.000 01]和改善患者肺功能[SMD=0.76,95%CI(0.59,0.94),P<0.000 01]。养阴清肺汤及养阴清肺口服液联合常规治疗在治疗成人慢性咳嗽方面的临床疗效也优于对照组[RR=1.41,95%CI(1.22,1.64),P<0.000 01]。在安全性方面,养阴清肺汤组出现不良反应7例,对照组出现13例,两组不良反应类型和程度基本一致。结论养阴清肺汤联合常规治疗能提高慢性咳嗽和慢性阻塞性肺疾病临床疗效,其安全性也尚可。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以证实。
Objective To systematically review the efficacy and safety of Yangyinqingfei decoction for chronic cough and chronic obstructive pulmonary disease(COPD) patients. Methods We electronically searched databases including Pub Med, Web of Science, CBM, CNKI, VIP and Wan Fang Data for randomized controlled trials(RCTs) of Yangyinqingfei decoction for chronic cough and COPD patients from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, Rev Man 5.3software was used for meta-analysis. Results Twenty-four RCTs involving 2 268 patients with COPD and chronic cough were included. The results of meta-analysis showed that compared with the control group, Yangyinqingfei decoction combined with the conventional medicine could significantly improve clinical effective rate(RR=1.21, 95%CI 1.16 to 1.27,P<0.000 01) and lung function(SMD=0.76, 95%CI 0.59 to 0.94, P<0.000 01) in patients with COPD. Yangyinqingfei decoction combined with the conventional medicine group was superior to the control group(RR=1.41, 95%CI 1.22 to1.64, P<0.000 01) in clinical efficacy for adults patients with chronic cough. In terms of safety, seven cases occurred adverse reactions in the Yangyinqingfei decoction group,while 13 were found in the control group,the types and degree of adverse reactions in both groups were almost the same.Conclusion The combination of Yangyinqingfei plus conventional medicine may significantly improve the clinical efficacy for chronic cough and COPD with reliable safety.However,due to the limited quality and quantity of included studies,the above conclusions are needed to verify by more high quality studies.
Objective To systematically review the efficacy and safety of Yangyinqingfei decoction for chronic cough and chronic obstructive pulmonary disease(COPD) patients. Methods We electronically searched databases including Pub Med, Web of Science, CBM, CNKI, VIP and Wan Fang Data for randomized controlled trials(RCTs) of Yangyinqingfei decoction for chronic cough and COPD patients from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, Rev Man 5.3software was used for meta-analysis. Results Twenty-four RCTs involving 2 268 patients with COPD and chronic cough were included. The results of meta-analysis showed that compared with the control group, Yangyinqingfei decoction combined with the conventional medicine could significantly improve clinical effective rate(RR=1.21, 95%CI 1.16 to 1.27,P<0.000 01) and lung function(SMD=0.76, 95%CI 0.59 to 0.94, P<0.000 01) in patients with COPD. Yangyinqingfei decoction combined with the conventional medicine group was superior to the control group(RR=1.41, 95%CI 1.22 to1.64, P<0.000 01) in clinical efficacy for adults patients with chronic cough. In terms of safety, seven cases occurred adverse reactions in the Yangyinqingfei decoction group,while 13 were found in the control group,the types and degree of adverse reactions in both groups were almost the same.Conclusion The combination of Yangyinqingfei plus conventional medicine may significantly improve the clinical efficacy for chronic cough and COPD with reliable safety.However,due to the limited quality and quantity of included studies,the above conclusions are needed to verify by more high quality studies.
引文
1Global strategy for the diagnosis,management and prevention of chronic obstructive pulmonary disease(updated 2016).Available at:http://goldcopd.org/global-strategy-diagnosis-managementprevention-copd-2016.
2 中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2015).中华结核和呼吸杂志,2016,39(5):323-354.
3 Higgins JP,Green S.Cochrane Handbook for Systematic Reviews of Interventions(Version 5.1.0).Available at:http://www.cochranehandbook.org.
4杜万朋.养阴清肺汤联合头孢呋辛钠治疗慢性阻塞性肺气肿60例临床观察.中国民族民间医药,2015,24(14):51-52.
5王宁德,李莉.养阴清肺汤联合西药治疗老年慢性肺气肿临床疗效.陕西中医,2015,36(7):827-828.
6孔令魁.养阴清肺汤在老年慢性阻塞性肺气肿治疗中的疗效分析.临床心身疾病杂志,2015,21(z1):256.
7高轶峰,崔红,刘宾娜.养阴清肺汤治疗老年慢性阻塞性肺气肿.中国实验方剂学杂志,2011,17(4):204-205.
8谭国柱.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.中医临床研究,2014,6(23):73-74.
9朱文平.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.大家健康(学术版),2014,8(4):54.
10谢小芹,元文峰,邹萍.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.医学信息,2013,6(29):134.
11兰映天.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.现代养生,2012,7(16):71-73.
12谢杏爱.养阴清肺汤治疗老年慢性阻塞性肺气肿疗效分析.按摩与康复医学,2014,5(1):126-127.
13张定学,张著勋.养阴清肺汤治疗老年慢性阻塞性肺气肿疗效观察.现代中西医结合杂志,2014,23(13):1447-1448.
14何龙.养阴清肺汤治疗慢性阻塞性肺气肿的临床疗效观察.中国医药指南,2016,14(12):8-9.
15宁静,程永华.养阴清肺汤治疗痰热郁肺型老年COPD的临床观察.中医临床研究,2015,7(31):78-80.
16盖莹.中西医结合治疗慢性阻塞性肺气肿临床效果分析.中国中医药咨讯,2012,4(1):214.
17王建华,李梅娟.中西医结合治疗慢性阻塞性肺气肿30例临床观察.国际医药卫生导报,2010,16(5):572-573.
18倪敏.养阴清肺汤联合糖皮质激素治疗老年慢性阻塞性肺气肿临床观察.新中医,2015,47(1):70-71.
19董日.养阴清肺汤治疗老年慢性阻塞性肺气肿44例.江西中医药,2014,45(383):33-34.
20岳团华.养阴清肺汤治疗老年慢性阻塞性肺气肿临床疗效观察.亚太传统医药,2014,10(20):117-118.
21周明.养阴清肺汤治疗老年慢性阻塞性肺气肿的疗效观察.现代诊断与治疗,2013,24(15):3420-3421.
22郑远方.中西结合治疗慢性阻塞性肺气肿128例临床疗效研究.中外医疗,2012,31(19):113.
23於志娟.养阴清肺汤加减治疗小儿上气道咳嗽综合征75例疗效观察.内蒙古中医药,2010,29(22):10.
24唐洁芬,余培煌.养阴清肺汤联合孟鲁司特治疗小儿支原体感染肺炎后慢性咳嗽临床观察.四川中医,2016,34(8):72-75.
25安立,李林.养阴清肺汤联合西药治疗慢性咽炎随机平行对照研究.实用中医内科杂志,2016,30(3):61-63.
26赵秀贞.用养阴清肺汤治疗慢性咽炎的远期疗效与安全性分析.当代医药论丛,2014,34(8):14-16.
27穆传军,李振山,孙兆勋.养阴清肺口服液治疗慢性咽炎80例疗效观察.山东中医杂志,2006,25(2):91-92.
2 中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2015).中华结核和呼吸杂志,2016,39(5):323-354.
3 Higgins JP,Green S.Cochrane Handbook for Systematic Reviews of Interventions(Version 5.1.0).Available at:http://www.cochranehandbook.org.
4杜万朋.养阴清肺汤联合头孢呋辛钠治疗慢性阻塞性肺气肿60例临床观察.中国民族民间医药,2015,24(14):51-52.
5王宁德,李莉.养阴清肺汤联合西药治疗老年慢性肺气肿临床疗效.陕西中医,2015,36(7):827-828.
6孔令魁.养阴清肺汤在老年慢性阻塞性肺气肿治疗中的疗效分析.临床心身疾病杂志,2015,21(z1):256.
7高轶峰,崔红,刘宾娜.养阴清肺汤治疗老年慢性阻塞性肺气肿.中国实验方剂学杂志,2011,17(4):204-205.
8谭国柱.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.中医临床研究,2014,6(23):73-74.
9朱文平.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.大家健康(学术版),2014,8(4):54.
10谢小芹,元文峰,邹萍.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.医学信息,2013,6(29):134.
11兰映天.养阴清肺汤治疗老年慢性阻塞性肺气肿的临床观察.现代养生,2012,7(16):71-73.
12谢杏爱.养阴清肺汤治疗老年慢性阻塞性肺气肿疗效分析.按摩与康复医学,2014,5(1):126-127.
13张定学,张著勋.养阴清肺汤治疗老年慢性阻塞性肺气肿疗效观察.现代中西医结合杂志,2014,23(13):1447-1448.
14何龙.养阴清肺汤治疗慢性阻塞性肺气肿的临床疗效观察.中国医药指南,2016,14(12):8-9.
15宁静,程永华.养阴清肺汤治疗痰热郁肺型老年COPD的临床观察.中医临床研究,2015,7(31):78-80.
16盖莹.中西医结合治疗慢性阻塞性肺气肿临床效果分析.中国中医药咨讯,2012,4(1):214.
17王建华,李梅娟.中西医结合治疗慢性阻塞性肺气肿30例临床观察.国际医药卫生导报,2010,16(5):572-573.
18倪敏.养阴清肺汤联合糖皮质激素治疗老年慢性阻塞性肺气肿临床观察.新中医,2015,47(1):70-71.
19董日.养阴清肺汤治疗老年慢性阻塞性肺气肿44例.江西中医药,2014,45(383):33-34.
20岳团华.养阴清肺汤治疗老年慢性阻塞性肺气肿临床疗效观察.亚太传统医药,2014,10(20):117-118.
21周明.养阴清肺汤治疗老年慢性阻塞性肺气肿的疗效观察.现代诊断与治疗,2013,24(15):3420-3421.
22郑远方.中西结合治疗慢性阻塞性肺气肿128例临床疗效研究.中外医疗,2012,31(19):113.
23於志娟.养阴清肺汤加减治疗小儿上气道咳嗽综合征75例疗效观察.内蒙古中医药,2010,29(22):10.
24唐洁芬,余培煌.养阴清肺汤联合孟鲁司特治疗小儿支原体感染肺炎后慢性咳嗽临床观察.四川中医,2016,34(8):72-75.
25安立,李林.养阴清肺汤联合西药治疗慢性咽炎随机平行对照研究.实用中医内科杂志,2016,30(3):61-63.
26赵秀贞.用养阴清肺汤治疗慢性咽炎的远期疗效与安全性分析.当代医药论丛,2014,34(8):14-16.
27穆传军,李振山,孙兆勋.养阴清肺口服液治疗慢性咽炎80例疗效观察.山东中医杂志,2006,25(2):91-92.