六君子汤加减治疗稳定期慢性阻塞性肺疾病肺脾两虚证的Meta分析

Meta-analysisof addition and subtraction of Liujunzi Decoction in the treatment of stable lung and spleen deficiency syndrome of chronic obstructive pulmonary disease

关键词:  六君子汤  慢性阻塞性肺疾病  稳定期  肺脾两虚证  Meta分析

Key words:  Liujunzi Decoction  chronic obstructive pulmonary disease  stable period  lung and spleen deficiency syndrome  Meta-analysis

摘要:

[目的] 评价六君子汤加减治疗稳定期慢性阻塞性肺疾病肺脾两虚证的有效性及安全性。[方法] 检索PubMed、Embase、Cochrane图书馆、中国知网、万方、维普、中国生物医学数据库，搜集六君子汤加减治疗稳定期慢性阻塞性肺疾病合并肺脾两虚证的随机对照试验（RCT），时间限定为建库至2019年3月。使用RevMan 5.3进行Meta分析。[结果] 纳入10篇文献，包括870例患者。Meta分析结果显示：六君子汤加减可提高总有效率[OR=3.10，95%CI（2.13，4.51），P<0.000 01]，改善部分肺功能指标，包括第1秒用力呼气容积（FEV1）[SMD=0.73，95%CI（0.29，1.18），P=0.001]、第1秒用力呼气量占所有呼气量的比例（FEV1/FVC）[SMD=0.75，95%CI（0.41，1.09），P<0.000 1]；但用力肺活量（FVC）[SMD=0.28，95%CI（-0.24，0.81），P=0.27]，差异无统计学意义。改善部分动脉血气分析指标，包括血氧饱合度（SaO₂）[SMD=0.94，95%CI（0.21，1.67），P=0.01]、动脉血二氧化碳分压（PaCO₂）[SMD=-1.71，95%CI（-2.02，-1.40），P<0.000 01]；但动脉血氧分压（PaO₂）[SMD=2.71，95%CI（-0.44，5.86），P=0.09]，差异无统计学意义。改善中医症状积分，包括咳嗽[SMD=-1.16，95%CI（-1.76，-0.55），P=0.0002]、咳痰[SMD=-0.80，95%CI（-1.48，-0.13），P=0.02]、气短[SMD=-0.43，95%CI（-0.71，-0.14），P=0.003]、食少[SMD=-1.00，95%CI（-1.30，-0.70），P<0.000 01]、腹胀[SMD=-1.09，95%CI（-1.39，-0.79），P<0.000 01]，提高运动耐力[SMD=0.94，95%CI（0.10，1.77），P=0.03]，改善呼吸困难量表（MMRC）[SMD=-0.58，95%CI（-0.82，-0.34），P<0.000 01]；在体重指数（BMI）方面，两组差异无统计学意义[SMD=-0.41，95%CI（-1.37，0.55），P=0.41]。[结论] 六君子汤加减治疗稳定期慢性阻塞性肺疾病合并肺脾两虚证有疗效优势。

Abstract:

[Objective] To evaluate the efficacy and safety of addition and subtraction of Liujunzi Decoction in the treatment of stable lung and spleen deficiency syndrome in patients with chronic obstructive pulmonary disease. [Methods] Searching with PubMed, EMBASE, Cochrane Library, China knowledge Network, Wanfang, Weipu, China Biomedical Database, to collect the randomized controlled trial of addition and subtraction of Liujunzi Decoction in the treatment of stable lung and spleen deficiency syndrome of chronic obstructive pulmonary disease(COPD). Time was limited to the establishment of the database until March 2019 by RevMan 5.3. [Results] The total of 10 articles were included, including 870 patients. The results of Meta-analysis showed that the addition and subtraction of Liujunzi Decoction can improve the total effective rate[OR=3.10, 95%CI(2.13, 4.51), P<0.000 01], improve some pulmonary function indicators like FEV1[SMD=0.73, 95%CI (0.29, 1.18), P=0.001], FEV1/FVC[SMD=0.75, 95%CI (0.41, 1.09), P<0.000 1], however, the difference was not statistically significant in FVC[SMD=0.28, 95%CI (-0.24, 0.81), P=0.27]. It can improve some arterial blood gas analysis indicators like SaO₂[SMD=0.94, 95%CI(0.21, 1.67), P=0.01], PaCO₂[SMD=-1.71, 95%CI(-2.02, -1.40), P<0.000 01]), but the difference of PaO₂[SMD=2.71, 95%CI(-0.44, 5.86), P=0.09] had no statistical significance. It can improve TCM syndrome scores (Cough[SMD=-1.16, 95%CI(-1.76, -0.55), P=0.000 2], expectoration[SMD=-0.80, 95%CI(-1.48, -0.13), P=0.02], short breath[SMD=-0.43, 95%CI (-0.71, -0.14), P=0.003], eat less[SMD=-1.00, 95%CI (-1.30, -0.70), P<0.000 01], abdominal distension[SMD=-1.09, 95%CI(-1.39, -0.79), P<0.000 01]). It can improve exercise endurance[SMD=0.94, 95%CI (0.10, 1.77), P=0.03], improve MMRC[SMD=-0.58, 95%CI(-0.82, -0.34), P<0.000 01]. There was no significant statistical difference in BMI between the two groups[SMD=-0.41, 95%CI(-1.37, 0.55), P=0.41]. [Conclusion] Addition and subtraction of Liujunzi Decoction has curative and effective advantages in the treatment of stable lung and spleen deficiency syndrome of chronic obstructive pulmonary disease.