益气活血法治疗慢性阻塞性肺疾病急性加重期的Meta分析

Meta analysis of Yiqi Huoxue method in treating acute exacerbation of chronic obstructive pulmonary disease

关键词:  慢性阻塞性肺疾病急性加重期  益气活血法  Meta分析

Key words:  acute exacerbation of chronic obstructive pulmonary disease  Yiqi Huoxue method  Meta analysis

摘要:

[目的] 系统评价益气活血法治疗慢性阻塞性肺疾病急性加重期（AECOPD）的有效性及安全性。[方法] 通过计算机检索中国知网、PubMed等7个中英文数据库，检索时限为建库—2019年7月，收集相关益气活血法治疗AECOPD的临床随机对照试验（RCT）。分别需要2位研究者，依据纳排标准独立筛查文献、提取相关数据等资料，然后用偏倚风险评价工具Cochrane对RCT文献质量进行评价，运用RevMan5.3软件行Meta分析，系统评价益气活血法治疗AECOPD的临床疗效、肺功能、血气改善情况。共纳入11篇RCT，包括818例患者。[结果] 与对照组比较，益气活血组临床有效率更高[RR=1.20，95%CI（1.14，1.27），P<0.000 01]；肺功能改善明显，包括第1秒呼吸容积占用力肺活量百分比（FEV1/FVC）[MD=6.65，95%CI（3.97，9.33），P<0.000 01]、第1秒呼气量（FEV1）[MD=0.40，95%CI（0.16，0.64），P<0.000 01]、第1秒呼气量占预计值百分比（FEV1% pre）[MD=9.10，95%CI（3.70，14.49），P<0.000 01]和用力肺活量（FVC）[MD=1.52，95%CI（-0.21，3.26），P<0.000 01]；同时能改善血气水平，包括降低动脉血二氧化碳分压（PaCO₂）[MD=－8.14，95%CI（－13.25，－3.04），P<0.000 01]、升高动脉血氧分压（PaO₂）[MD=7.28，95%CI（3.38，11.18），P<0.000 01]和调节动脉血酸碱度值（pH）[MD=0.06，95%CI（-0.02，0.13），P=0.001]；同时统计临床资料中使用频次居前6位的中药，依次是丹参、黄芪、桔梗、党参、白术、甘草。目前证据表明临床治疗AECOPD时，应注重中医益气活血法的使用，同时重视丹参、黄芪、桔梗、党参等中药的灵活合理应用。并且益气活血组的不良反应发生率低。[结论] 在常规西医基础治疗基础上加益气活血中药治疗AECOPD，可提高临床疗效，改善肺功能，调节血气指标，但因纳入研究数量及质量的限制，尚缺少高质量证据证实益气活血法的临床疗效，因此需更多设计严谨、大样本的多中心RCT加以验证。

Abstract:

[Objective] To systematically evaluate the effectiveness and safety of Yiqi Huoxue method in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).[Methods] Seven Chinese and English databases including CNKI and PubMed were searched by computer,and the search time limit was from the establishment of the database to July 2019 to collect clinical randomized controlled trials(RCT) related to the treatment of AECOPD by Yiqi Huoxue method. Two researchers were needed to independently screen the literature and extract the relevant data according to the standard,and then the quality of the randomized controlled trial literature was evaluated by the bias risk assessment tool Cochrane,and the Meta analysis was performed by RevMan 5.3 software. The clinical efficacy,pulmonary function and blood gas improvement of Yiqi Huoxue method in the treatment of AECOPD were systematically evaluated. A total of 11 RCT articles were included,including 818 patients.[Results] The clinical effective rate of Yiqi Huoxue group was higher than that of the control group[RR=1.20,95%CI(1.14,1.27),P<0.000 01]). Pulmonary function improved significantly,including the percentage of respiratory volume in first second to forced vital capacity (FEV1/FVC)[MD=6.65,95%CI(3.97,9.33),P<0.000 01],FEV1[MD=0.40,95%CI(0.16,0.64),P<0.000 01],percentage of inspiratory volume in the first second to the expected value (FEV1% pre)[MD=9.10,95%CI(3.70,14.49),P<0.000 01] and forced vital capacity (FVC)[MD=1.52,95%CI(-0.21,3.26),P<0.000 01];at the same time,it can improve the blood gas level,including reducing the partial pressure of carbon dioxide (PaCO₂)[MD=-8.14,95%CI(-13.25,-3.04),P<0.000 01] and increasing the partial pressure of oxygen in arterial blood (PaO₂)[MD=7.28,95%CI(3.38,11.18),P<0.000 01] and (pH)[MD=0.06,95%CI(-0.02,0.13),P=0.001];at the same time,the top 6 Chinese herbs were used in clinical data,followed by Salvia miltiorrhiza,Radix astragali,Platycodon grandiflorum,Codonopsis pilosula,Atractylodes macrocephala and Glycyrrhiza uralensis. At present,the evidence shows that in the clinical treatment of AECOPD,we should pay attention to the use of traditional Chinese medicine,such as Salvia miltiorrhiza,Radix astragali,Platycodon grandiflorum,Codonopsis pilosula and so on. In addition,the incidence of adverse reactions in Yiqi Huoxue group was low.[Conclusion] It is suggested that on the basis of routine basic treatment of western medicine,the treatment of AECOPD,with traditional Chinese medicine for Yiqi Huoxue can improve clinical curative effect,improve lung function and regulate blood gas index. However,due to the limitation of the number and quality of included studies,there is still a lack of high-quality evidence to confirm the clinical efficacy of Yiqi Huoxue method,so more well-designed,large sample multicenter RCT are needed to verify it.