中药治疗COPD急性加重期的系统评价

Systemic evaluation of TCM for COPD in the acute stage of exacerbation

关键词:  慢性阻塞性肺疾病  急性加重期  系统评价  中药

Key words:  COPD  acute stage of exacerbation  systematic evaluation  TCM

摘要:

[目的]评价中药治疗慢性阻塞性肺疾病(COPD)急性加重期的疗效与安全性。[方法]计算机检索Cochrane图书馆(2005年第4期)、中国生物医学文献数据库(CBM1995-2006)、中国学术期刊全文数据库(CNKI1994-2006年)和中国中医药文献检索系统数据库(TCM1995-2005年)所收录的相关文献,收集以中药为干预措施治疗COPD急性加重期的随机对照试验,按Cochrane系统评价方法,对纳入研究逐个进行质量评价,而后采用RevMan4.2.10软件对提取资料进行Meta分析。[结果]共14项研究(1237例)符合纳入标准。合并后效应量治疗组与对照组比较:有效率明显升高;咳嗽、咯痰、气喘、啰音的病情积分则降低;用力肺活量(FVC)、第1秒用力呼气量(FEV1)、第1秒用力呼气量百分率(FEV1%)均增加,其权重均数差(WMD)和95%CI分别为[0.27,(0.12,0.43)]、[0.22,(0.15,0.29)]、[5.65,(2.90,8.39)];提高氧分压(PaO₂)[WMD=9.64,95%CI(6.46,12.83)]、减低二氧化碳分压(PaCO₂)[WMD=-5.19,95%CI(-7.33,-3.06)]。有3项试验报告了不良反应,如过敏反应、腹泻。[结论]常规西药治疗基础之上加用中药较不加用中药治疗COPD急性加重期会有一定的疗效,在改善临床症状和体征(咳嗽、咯痰、气喘、啰音)方面有一定的优势,也可改善患者的通气功能和血气变化,且不良反应少。但由于纳入研究的方法学质量普遍较低,影响了结论的可靠性,尚需高质量的证据给予有力的支持才能得出肯定的结论。

Abstract:

[Objective] To evaluate the efficacy and safety of traditional Chinese medicine (TCM) for treating COPD at Acute Stage of Exacerbation. [Methods] Randomized controlled trials (RCTs) were collected from Cochrane Library (issue 4, 2005), CBM (1995~2006), CNKI (1994~2005) and TCM (1995~2005). All trials of clinical therapeutic studies on COPD at acute stage of exacerbation by TCM were included and analyzed according to the criteria of the Cochrane Handbook. RevMan 4.2.10 software was used for data analysis. [Results] Fourteen RCTs involving 1237 patients were included. Meta-analysis indicated: TCM based on Western medicine was more effective than Western medicine only on effective power [RRcombioned=1.16,95%CI (1.11,1.21)],relieving cough [WMD=-3.46,95%CI (-4.77,-2.15)], stethocatharsis [WMD=-3.92,95%CI (-5.93,-1.92)], asthma [WMD=-1.65,95%CI (-2.54,-0.76)], and rales[WMD=-3.23,95%CI (-4.65,-1.81)], elevating FVC[WMD=0.27,95%CI (0.12,0.43)], FEV1[WMD=0.22,95%CI (0.15,0.29)], and FEV1%[WMD=5.65,95%CI (2.90,8.39)], raising PaO₂ [WMD=9.64,95%CI (6.46,12.83)], reducing PaCO₂[WMD=-5.19,95%CI (-7.33,-3.06)]. Three trials reported had side effects of TCM, such as allergic response and diarrhea. [Conclusion] TCM based on Western medicine is more effect than Western medicine only in treating COPD at acute stage of exacerbation, However, the quality of research method is not strong enough and therefore decreased the avalibility, so we can’t obtaine a reliable conclusion about the effects of TCM for treating COPD at tis period. More trials with high quality are needed.