麻黄汤加味联合西医常规方法治疗急性喘息型支气管炎随机对照试验的系统综述与Meta分析
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摘要
目的系统评价麻黄汤联合西医常规方法治疗急性喘息型支气管炎的疗效及安全性。方法检索中国知网、万方数字化期刊全文数据库、维普中文期刊数据库、中国生物医学文献数据库、PubMed、Cochrane Library,检索时间为从建库至2018年7月10日。采用Cochrane系统偏倚风险评估工具和GRADE系统推荐分级方法,对纳入研究的质量进行评估,并用RevMan 5. 3软件对治疗总有效率及喘鸣音、湿啰音、喘憋、咳嗽的消失时间进行Meta分析。结果共纳入15项随机对照试验,1342例患者,试验组均为麻黄汤加味联合西医常规治疗,对照组均为西医常规治疗。其中7项为中等风险偏倚,其余为高风险偏倚。Meta分析结果显示:与单纯西医常规治疗相比,麻黄汤加味联合西医常规治疗能够明显提高治疗总有效率[RR=1. 23,95%CI (1. 18,1. 28)],缩短喘鸣音消失时间[MD=-1. 72,95%CI (-1. 94,-1. 50)]、湿啰音消失时间[MD=-1. 61,95%CI (-1. 76,-1. 45)]、喘憋消失时间[MD=-1. 83,95%CI (-2. 06,-1. 60)]、咳嗽消失时间[MD=-2. 53,95%CI (-2. 96,-2. 11)]。GRADE评价结果显示:总有效率、喘鸣音消失时间、湿啰音消失时间、喘憋消失时间指标为中等质量证据,咳嗽消失时间指标为极低质量证据。结论麻黄汤加味联合西医常规治疗急性喘息型支气管炎在疗效及缩短症状时间方面优于单纯西医常规治疗,但由于纳入研究的证据质量多为中低等,故仍需要开展高质量、报告详细的随机对照试验以增加证据强度。
Objective To evaluate the efficacy and safety of Mahuang Decoction( 麻黄汤) combined with western medicine in the treatment of acute asthmatic bronchitis. Methods The databases of CNKI,Wangfang data,VIP,CBM,PubMed and Cochrane Library were searched from the founding date to July 10,2018. The quality included in these studies was evaluated with Cochrane risk of bias tool and GRADE standard. RevMan 5. 3 software was used for meta-analysis of total effective rate,disappear time of stridor,moist crackles,asthmatic suffocation and disappear time of cough. Results Totally 15 randomized controlled trials( RCTs) were involved with 1342 patients.The test group was given modified Mahuang Decoction and conventional western medicine treatment,and the control group was given conventional western medicine treatment. Seven items were moderate risk of bias,and the rest were the high risk of bias. The results of meta-analysis showed that compared with western medicine treatment alone,modified Mahuang Decoction and conventional western medicine treatment significantly improved the total effective rate( RR = 1. 23,95% CI [1. 18,1. 28]),shortened the disappear time of stridor( day)( MD =-1. 72,95% CI[-1. 94,-1. 50]),moist crackles( day)( MD =-1. 61,95% CI [-1. 76,-1. 45]),asthmatic suffocation( day)( MD =-1. 83,95% CI [-2. 06,-1. 60]) and cough( day)( MD =-2. 53,95% CI [-2. 96,-2. 11]). GRADE evaluation results showed that the indicator of total effective rate,disappear time of stridor,moist crackles and asthmatic suffocation were moderate quality evidence,and the disappearance time of cough was very lowquality evidence. Conclusion Mahuang Decoction together with western medicine therapy for acute wheezing bronchitis was better than western medicine therapy alone,but due to the quality of evidence is mostly medium and low,it is still necessary to conduct high-quality and detailed randomized controlled trials in order to increase the strength of evidence.
Objective To evaluate the efficacy and safety of Mahuang Decoction( 麻黄汤) combined with western medicine in the treatment of acute asthmatic bronchitis. Methods The databases of CNKI,Wangfang data,VIP,CBM,PubMed and Cochrane Library were searched from the founding date to July 10,2018. The quality included in these studies was evaluated with Cochrane risk of bias tool and GRADE standard. RevMan 5. 3 software was used for meta-analysis of total effective rate,disappear time of stridor,moist crackles,asthmatic suffocation and disappear time of cough. Results Totally 15 randomized controlled trials( RCTs) were involved with 1342 patients.The test group was given modified Mahuang Decoction and conventional western medicine treatment,and the control group was given conventional western medicine treatment. Seven items were moderate risk of bias,and the rest were the high risk of bias. The results of meta-analysis showed that compared with western medicine treatment alone,modified Mahuang Decoction and conventional western medicine treatment significantly improved the total effective rate( RR = 1. 23,95% CI [1. 18,1. 28]),shortened the disappear time of stridor( day)( MD =-1. 72,95% CI[-1. 94,-1. 50]),moist crackles( day)( MD =-1. 61,95% CI [-1. 76,-1. 45]),asthmatic suffocation( day)( MD =-1. 83,95% CI [-2. 06,-1. 60]) and cough( day)( MD =-2. 53,95% CI [-2. 96,-2. 11]). GRADE evaluation results showed that the indicator of total effective rate,disappear time of stridor,moist crackles and asthmatic suffocation were moderate quality evidence,and the disappearance time of cough was very lowquality evidence. Conclusion Mahuang Decoction together with western medicine therapy for acute wheezing bronchitis was better than western medicine therapy alone,but due to the quality of evidence is mostly medium and low,it is still necessary to conduct high-quality and detailed randomized controlled trials in order to increase the strength of evidence.
引文
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[2]BALSHEM H,HELFAND M,SCHNEM ANU HJ,et al.GRADE guidelines:3. Rating the quality of evidence[J].J Clin Epidemiol,2011,64(4):401-406.
[3]冯勇.麻黄汤加减治疗急性喘息型支气管炎疗效观察[J].世界最新医学信息文摘,2016,16(25):173-174.
[4]郝振友.浅析麻黄汤加减治疗急性喘息型支气管炎疗效观察[J].世界最新医学信息文摘,2016,16(29):152,158.
[5]李陈泽.麻黄汤加减治疗48例急性喘息型支气管炎的临床效果探讨[J].医药,2015(8):106.
[6]李继增.麻黄汤加减治疗急性喘息型支气管炎疗效观察[J].世界最新医学信息文摘,2016,16(41):159,166.
[7]凌永爱.中药麻黄汤加减治疗42例急性喘息型支气管炎的疗效分析[J].大家健康—学术版,2014,8(19):148-149.
[8]卢霞.麻黄汤加减治疗风寒闭肺型急性喘息性支气管炎的临床分析[J].中国医药指南,2014,12(21):265-266.
[9]齐凯.麻黄汤加减治疗急性喘息型支气管炎疗效观察[J].中国保健营养,2016,26(21):325-326.
[10]谭玉梅.急性喘息型支气管炎经麻黄汤加减治疗的效果探究[J].双足与保健,2017,26(3):72-73.
[11]王学航.麻黄汤治疗急性喘息型支气管炎42例[J].中国中医药现代远程教育,2014,12(8):45-46.
[12]王志雄.麻黄汤加减运用在治疗急性喘息型支气管炎患者中的价值探讨[J].世界最新医学信息文摘,2017,17(34):151.
[13]熊丽.急性喘息型支气管炎患者采用麻黄汤加减治疗的临床疗效分析[J].中外医疗,2017,36(21):161-163.
[14]张丽.中药麻黄汤加减方治疗急性喘息型支气管炎的效果探讨[J].海峡药学,2017,29(12):166-167.
[15]张伟霞,白岩.麻黄汤加减治疗急性喘息型支气管炎疗效观察[J].陕西中医,2012,33(12):1572-1573.
[16]赵英龙.急性喘息型支气管炎采用麻黄汤加减治疗的临床效果报告[J].中国疗养医学,2014,23(7):607-608.
[17]周莉娜.麻黄汤加减治疗急性喘息型支气管炎的临床观察[J].中国民间疗法,2018,26(4):24-25.
[18]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:219.
[19]张保国,刘庆芳.麻黄汤现代药效学研究及临床应用[J].中成药,2007,3(5):33-34.