3种中药注射剂治疗慢性阻塞性肺疾病急性加重期的网状Meta分析
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摘要
该研究系统评价3种中药注射剂(CMI)联合西医常规治疗慢性阻塞性肺疾病急性加重(AECOPD)对肺功能的影响和安全性。计算机检索PubMed、Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方(WanFang)和维普(VIP)数据库(检索时限均从建库至2018年7月),搜集有关临床常用的3种中药注射液(喘可治注射液、痰热清注射液、血必净注射液)辅助治疗慢性阻塞性肺疾病急性加重的随机对照试验。对纳入研究进行质量评价和数据提取,用软件Stata 14做网状Meta分析,用RevMan 5.3作风险偏倚图。最终纳入4个RCTs、20个半随机对照试验,共计579例AECOPD患者。网状Meta分析显示:①3种CMI与对照组第1秒用力呼气容积(FEV1)间均有统计学差异,CMI之间均无统计学差异;②3种CMI联合西医常规治疗AECOPD,根据第1秒用力呼气容积的频率排序结果,痰热清注射液联合西医常规治疗改善FEV1更为显著,其次为血必净注射液联合西医常规治疗、喘可治注射液联合西医常规治疗。基于目前的证据,3种CMI均能在西医常规治疗AECOPD的基础上进一步改善FEV1。另外该研究结论仍需要大量设计合理、方法得当的RCTs给予证实。
To evaluate the efficacy and safety of traditional Chinese medicine injections( CMI) in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD). PubMed,Cochrane Library,CNKI,CBM,Wan Fang and VIP database( since the date of database establishment to July 2018) were retrieved through computer for controlled randomized trials( CRTs) of 3 kinds of traditional Chinese medicine injections( Chuankezhi Injection,Tanreqing Injection,Xuebijing Injection) for AECOPD. After the methodological quality of included researches were evaluated,and the valid data were extracted,statistical analysis was performed with Stata 14,RevMan 5.3 is used for risk bias map. There were including 4 RCTs and 20 quasi-RCTs,which involving 579 patients.The results of network Meta-analysis showed that: ①there were significant differences in the forced expiratory volume in the first second between the 3 CMI and control groups,and there was no significant difference between CMI; ②3 kinds of CMI adjuvant therapy AECOPD,According to the forced expiratory volume in the first second of the probability ranking results,Tanreqing Injection is more effective,followed by Xuebijing Injection and Chuankezhi Injection. Based on the present evidence,3 kinds of CMI can improve the forced expiratory volume in the first second on the basis of Western medicine routine treatment of AECOPD,having better safty. In addition,the conclusion of this study still needs a large number of RCTs with reasonable design and proper method to confirm it.
To evaluate the efficacy and safety of traditional Chinese medicine injections( CMI) in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD). PubMed,Cochrane Library,CNKI,CBM,Wan Fang and VIP database( since the date of database establishment to July 2018) were retrieved through computer for controlled randomized trials( CRTs) of 3 kinds of traditional Chinese medicine injections( Chuankezhi Injection,Tanreqing Injection,Xuebijing Injection) for AECOPD. After the methodological quality of included researches were evaluated,and the valid data were extracted,statistical analysis was performed with Stata 14,RevMan 5.3 is used for risk bias map. There were including 4 RCTs and 20 quasi-RCTs,which involving 579 patients.The results of network Meta-analysis showed that: ①there were significant differences in the forced expiratory volume in the first second between the 3 CMI and control groups,and there was no significant difference between CMI; ②3 kinds of CMI adjuvant therapy AECOPD,According to the forced expiratory volume in the first second of the probability ranking results,Tanreqing Injection is more effective,followed by Xuebijing Injection and Chuankezhi Injection. Based on the present evidence,3 kinds of CMI can improve the forced expiratory volume in the first second on the basis of Western medicine routine treatment of AECOPD,having better safty. In addition,the conclusion of this study still needs a large number of RCTs with reasonable design and proper method to confirm it.
引文
[1] From the global strategy for the diagnosis,management and prevention of COPD,global initiative for chronic obstructive lung disease(GOLD)2017[EB/OL].[2018-10-11]. http://goldcopd.org.
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[3] Burge S,Wedzicha J A. COPD exacerbations:definitions and classifications[J]. Eur Respir J Suppl,2003,41:46.
[4] Kiser T H,Vandivier R W. Severe acute exacerbations of chronic obstructive pulmonary disease:does the dosage of corticosteroids and type of antibiotic matter?[J]. Curr Opin Pulm Med,2015,21(2):142.
[5]张弘,蔡柏蔷.慢性阻塞性肺疾病急性加重临床研究进展[J].中国呼吸与危重监护杂志,2016,15(2):198.
[6]寇爽,李立,姜帆,等.中药复方抗流感病毒作用机制研究概述[J].中医杂志,2014,55(10):885.
[7]慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2002(8):8.
[8]王东.喘可治配合西药治疗肺肾气虚型COPD急性加重期疗效观察[J].陕西中医,2015(2):168.
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[11]付海卫,张添威,李小波,等.血必净注射液对AECOPD患者动脉血气及肺功能指标的影响[J].中华全科医学,2014(1):78.
[12]李媛.血必净注射液治疗老年慢性阻塞性肺病急性期[J].中国实验方剂学杂志,2016(3):188.
[13]赵莉.血必净注射液治疗慢性阻塞性肺病急性加重期疗效观察[J].天津药学,2013(1):46.
[14]李松,华绪柏.痰热清治疗慢性阻塞性肺疾病急性加重期的临床观察[J].中国实用内科杂志,2009(S2):71.
[15]潘颖,付秀华,高俊珍,等.痰热清注射液联合基础疗法治疗AECOPD的疗效及对血清细胞因子的影响[J].中医药导报,2015(15):66.
[16]龙海.痰热清注射液治疗慢性阻塞性肺疾病急性加重期124例临床观察[J].中国中医急症,2012(6):966.
[17]陈智玲,胡永峰,肖海霞.痰热清注射液治疗慢性阻塞性肺疾病临床观察[J].中国中医急症,2009(9):1411.
[18]李希,黄河清,张川林.中西医结合治疗慢性阻塞性肺疾病的临床观察[J].中国现代药物应用,2008(4):83.
[19]王湘华,刘小军.中西医结合治疗慢性阻塞性肺疾病急性加重期39例临床观察[J].中医药导报,2011(7):29.
[20]刘家宝.痰热清注射液治疗慢性阻塞性肺疾病疗效观察[J].中药药理与临床,2012(2):171.
[21]黄斌,黄启祥,卢东生,等.痰热清注射液治疗慢性阻塞性肺疾病急性加重期临床研究[J].中国中医急症,2006(5):464.
[22]王彤兵.痰热清注射液治疗慢性阻塞性肺疾病急性加重期[J].中国实用医刊,2015(17):32.
[23]韦思尊,陈斯宁,冯原.痰热清注射液对慢性阻塞性肺疾病急性加重期患者细胞因子和肺功能影响的研究[J].中国中医急症,2011(9):1402.
[24]闫振华.痰热清注射液对慢性阻塞性肺疾病急性加重期的疗效分析[J].基层医学论坛,2014(16):2063.
[25]刘宗贵.痰热清注射液对慢性阻塞性肺病急性加重期的疗效分析[J].河南医学研究,2014(3):121.
[26]胡晓琳,戴晓彬,柯正华,等.痰热清和血必净治疗慢性阻塞性肺疾病急性加重期的疗效比较[J].现代药物与临床,2016(11):1732.
[27]王海哨,杨宗义,陈绍奉.喘可治注射液联合沙美特罗丙酸氟替卡松治疗慢性阻塞性肺疾病急性加重期的疗效分析[J].现代实用医学,2017(6):787.
[28]韩涛,孙存海.喘可治穴位注射治疗慢性阻塞性肺疾病急性发作的疗效观察[J].新疆中医药,2015(3):24.
[29]朱越燕,张孝钦,薛骞.喘可治雾化治疗COPD急性发作期疗效观察[J].中药材,2015(4):875.
[30]张孝钦.喘可治雾化吸入治疗慢性阻塞性肺疾病急性发作的疗效观察[J].中国中西医结合急救杂志,2011(5):270.
[31]方诚.痰热清注射液联合思力华治疗对慢性阻塞性肺疾病患者肺功能的影响[J].新中医,2015(6):45.
[32]李建生,余学庆,王明航,等.中医治疗慢性阻塞性肺疾病研究的策略与实践[J].中华中医药杂志,2012,27(6):1607.
[33]张俊华,任经天,胡镜清,等.中药注射剂临床安全性集中监测研究设计与实施专家共识[J].中国中药杂志,2017,42(1):6.
[34]张开宇,柏林燕,周建军,等.临床常用中药制剂治疗慢性阻塞性肺疾病的研究进展[J].中医药导报,2015,21(24):100.
[35]逄莉莉.血必净联合抗生素治疗ICU重症肺部感染的效果观察及评估[J].中国实用医药,2018,13(9):127.
[36]郑金粟,顾立刚.痰热清注射液对流感病毒FM-1感染小鼠抗病毒作用的研究[J].中华中医药杂志,2009,24(7):851.
[37]方凤,徐明玉,蒋瑾瑾,等.喘可治治疗小儿呼吸道病毒感染的临床和实验研究[J].上海中医药杂志,2003(8):36.
[38]连宝涛,刘枚芳,徐景利,等.血必净注射液治疗慢性阻塞性肺疾病的系统评价[J].中成药,2016,38(3):519.
[39]李国政,肖扬,隋洪飞,等.痰热清注射液治疗急性加重期慢性阻塞性肺疾病系统评价[J].山西中医,2016,32(10):11.
[40]陈诗琪,杨欣宇,唐潇旖,等.喘可治注射液治疗慢性阻塞性肺疾病急性加重期的系统评价[J].中国中药杂志,2017,42(14):2789.
[2]慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志:电子版,2014,6(2):67.
[3] Burge S,Wedzicha J A. COPD exacerbations:definitions and classifications[J]. Eur Respir J Suppl,2003,41:46.
[4] Kiser T H,Vandivier R W. Severe acute exacerbations of chronic obstructive pulmonary disease:does the dosage of corticosteroids and type of antibiotic matter?[J]. Curr Opin Pulm Med,2015,21(2):142.
[5]张弘,蔡柏蔷.慢性阻塞性肺疾病急性加重临床研究进展[J].中国呼吸与危重监护杂志,2016,15(2):198.
[6]寇爽,李立,姜帆,等.中药复方抗流感病毒作用机制研究概述[J].中医杂志,2014,55(10):885.
[7]慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2002(8):8.
[8]王东.喘可治配合西药治疗肺肾气虚型COPD急性加重期疗效观察[J].陕西中医,2015(2):168.
[9]黄东晖,李硕.喘可治配合西药治疗慢性阻塞性肺疾病急性加重期50例[J].陕西中医,2009(8):951.
[10]廖慧丽,孙维广.喘可治注射液治疗慢性阻塞性肺疾病急性加重期疗效观察[J].中国中医药信息杂志,2008(3):77.
[11]付海卫,张添威,李小波,等.血必净注射液对AECOPD患者动脉血气及肺功能指标的影响[J].中华全科医学,2014(1):78.
[12]李媛.血必净注射液治疗老年慢性阻塞性肺病急性期[J].中国实验方剂学杂志,2016(3):188.
[13]赵莉.血必净注射液治疗慢性阻塞性肺病急性加重期疗效观察[J].天津药学,2013(1):46.
[14]李松,华绪柏.痰热清治疗慢性阻塞性肺疾病急性加重期的临床观察[J].中国实用内科杂志,2009(S2):71.
[15]潘颖,付秀华,高俊珍,等.痰热清注射液联合基础疗法治疗AECOPD的疗效及对血清细胞因子的影响[J].中医药导报,2015(15):66.
[16]龙海.痰热清注射液治疗慢性阻塞性肺疾病急性加重期124例临床观察[J].中国中医急症,2012(6):966.
[17]陈智玲,胡永峰,肖海霞.痰热清注射液治疗慢性阻塞性肺疾病临床观察[J].中国中医急症,2009(9):1411.
[18]李希,黄河清,张川林.中西医结合治疗慢性阻塞性肺疾病的临床观察[J].中国现代药物应用,2008(4):83.
[19]王湘华,刘小军.中西医结合治疗慢性阻塞性肺疾病急性加重期39例临床观察[J].中医药导报,2011(7):29.
[20]刘家宝.痰热清注射液治疗慢性阻塞性肺疾病疗效观察[J].中药药理与临床,2012(2):171.
[21]黄斌,黄启祥,卢东生,等.痰热清注射液治疗慢性阻塞性肺疾病急性加重期临床研究[J].中国中医急症,2006(5):464.
[22]王彤兵.痰热清注射液治疗慢性阻塞性肺疾病急性加重期[J].中国实用医刊,2015(17):32.
[23]韦思尊,陈斯宁,冯原.痰热清注射液对慢性阻塞性肺疾病急性加重期患者细胞因子和肺功能影响的研究[J].中国中医急症,2011(9):1402.
[24]闫振华.痰热清注射液对慢性阻塞性肺疾病急性加重期的疗效分析[J].基层医学论坛,2014(16):2063.
[25]刘宗贵.痰热清注射液对慢性阻塞性肺病急性加重期的疗效分析[J].河南医学研究,2014(3):121.
[26]胡晓琳,戴晓彬,柯正华,等.痰热清和血必净治疗慢性阻塞性肺疾病急性加重期的疗效比较[J].现代药物与临床,2016(11):1732.
[27]王海哨,杨宗义,陈绍奉.喘可治注射液联合沙美特罗丙酸氟替卡松治疗慢性阻塞性肺疾病急性加重期的疗效分析[J].现代实用医学,2017(6):787.
[28]韩涛,孙存海.喘可治穴位注射治疗慢性阻塞性肺疾病急性发作的疗效观察[J].新疆中医药,2015(3):24.
[29]朱越燕,张孝钦,薛骞.喘可治雾化治疗COPD急性发作期疗效观察[J].中药材,2015(4):875.
[30]张孝钦.喘可治雾化吸入治疗慢性阻塞性肺疾病急性发作的疗效观察[J].中国中西医结合急救杂志,2011(5):270.
[31]方诚.痰热清注射液联合思力华治疗对慢性阻塞性肺疾病患者肺功能的影响[J].新中医,2015(6):45.
[32]李建生,余学庆,王明航,等.中医治疗慢性阻塞性肺疾病研究的策略与实践[J].中华中医药杂志,2012,27(6):1607.
[33]张俊华,任经天,胡镜清,等.中药注射剂临床安全性集中监测研究设计与实施专家共识[J].中国中药杂志,2017,42(1):6.
[34]张开宇,柏林燕,周建军,等.临床常用中药制剂治疗慢性阻塞性肺疾病的研究进展[J].中医药导报,2015,21(24):100.
[35]逄莉莉.血必净联合抗生素治疗ICU重症肺部感染的效果观察及评估[J].中国实用医药,2018,13(9):127.
[36]郑金粟,顾立刚.痰热清注射液对流感病毒FM-1感染小鼠抗病毒作用的研究[J].中华中医药杂志,2009,24(7):851.
[37]方凤,徐明玉,蒋瑾瑾,等.喘可治治疗小儿呼吸道病毒感染的临床和实验研究[J].上海中医药杂志,2003(8):36.
[38]连宝涛,刘枚芳,徐景利,等.血必净注射液治疗慢性阻塞性肺疾病的系统评价[J].中成药,2016,38(3):519.
[39]李国政,肖扬,隋洪飞,等.痰热清注射液治疗急性加重期慢性阻塞性肺疾病系统评价[J].山西中医,2016,32(10):11.
[40]陈诗琪,杨欣宇,唐潇旖,等.喘可治注射液治疗慢性阻塞性肺疾病急性加重期的系统评价[J].中国中药杂志,2017,42(14):2789.