中药治疗新型冠状病毒感染的有效性与安全性系统评价

Systematic review of effectiveness and safety of traditional Chinese medicine for COVID-19 based on core outcome set

关键词:  新型冠状病毒感染  中药  系统评价  方法学  临床疗效

Key words:  COVID-19  traditional Chinese medicine  systematic review  methodology  clinical efficacy

摘要:

[目的] 系统评价中药在新型冠状病毒感染（COVID-19）各核心指标的有效性与安全性。[方法] 系统检索中国知网（CNKI）、中国生物医学文献服务系统（SinoMed）、万方数据知识服务平台（WanFang Database）、维普数据库（VIP）、PubMed、Embase、the Cochrane Library、Web of Science数据库，收集中药治疗COVID-19的随机对照试验（RCT），由2名评价员独立筛选文献、提取数据并进行文献质量评价，应用R软件进行数据分析。[结果] 研究共纳入33个中药治疗COVID-19的RCT，包括6 349位患者，涉及23种中药，纳入研究均存在一定程度偏倚风险。在核酸转阴时间方面，疏风解毒胶囊、葛根芩连丸、宣肺败毒方等可以缩短轻型患者的核酸转阴时间，金银花口服液、疏风解毒胶囊、宣肺败毒方等可以缩短中型患者的核酸转阴时间，葛根芩连丸可以缩短重型患者的核酸转阴时间。在住院时间方面，金银花口服液、痰热清注射液、清肺排毒汤可以缩短中型患者的住院时间，血必净注射液、痰热清注射液、清肺排毒汤可以缩短重型患者的住院时间。在转重/危重率方面，金银花口服液和连花清瘟胶囊可以降低中型患者的转重率，血必净注射液可以降低重型患者转危重率。在临床症状积分方面，六神胶囊、清肺排毒汤可以改善中型患者的临床症状积分。在病死率方面，血必净注射液可以降低重型患者病死率，参黄颗粒可以降低重型和危重型患者病死率。[结论] 中药联合西医常规治疗在COVID-19的治疗方面具有较好疗效，且不良反应发生率更低。但因纳入研究的局限性，上述结论仍然需要更多高质量研究进一步进行验证。

Abstract:

[Objective] To systematically evaluate the effectiveness and safety of traditional Chinese medicine(TCM) across core outcome indicators for COVID-19. [Methods] Systematically searched CNKI,SinoMed,WanFang Database,VIP,PubMed,Embase,the Cochrane Library,and Web of Science for randomized controlled trials(RCT) on TCM for COVID-19. Two reviewers independently screened studies,extracted data,and assessed methodological quality. Data analysis was performed using R software. [Results] Thirty-three RCTs involving 6 349 patients and 23 TCM formulations were included,all with some risk of bias. Regarding time to nucleic acid conversion:Shufeng Jiedu Capsule,Gegen Qinlian Pill,and Xuanfei Baidu Formula shortened this time in mild patients;Jinyinhua Oral Liquid,Shufeng Jiedu Capsule,and Xuanfei Baidu Formula did so in moderate patients;and Gegen Qinlian Pill shortened it in severe patients. For hospital stay:Jinyinhua Oral Liquid,Tanreqing Injection,and Qingfei Paidu Decoction reduced hospital stay for moderate patients,while Xuebijing Injection,Tanreqing Injection,and Qingfei Paidu Decoction did so for severe patients. For progression to severe/critical rate:Jinyinhua Oral Liquid and Lianhua Qingwen Capsule reduced progression in moderate patients,and Xuebijing Injection reduced progression to critical condition in severe patients. For clinical symptom scores:Liushen Capsule and Qingfei Paidu Decoction improved scores in moderate patients. For mortality:Xuebijing Injection reduced mortality in severe patients,and Shenhuang Granule reduced mortality in severe and critical patients. [Conclusion] TCM combined with conventional Western medicine demonstrates favorable efficacy for COVID-19 with a lower incidence of adverse reactions. However,due to limitations of the included studies,these findings require further validation by more high-quality research.