活血化瘀通络法治疗儿童肺炎支原体肺炎有效性及安全性的系统评价及Meta分析

Systematic review and Meta-analysis of the efficacy and safety of promoting blood circulation and removing blood stasis in the treatment of mycoplasma pneumoniae pneumonia in children

关键词:  肺炎支原体肺炎  儿童  活血化瘀通络法  Meta分析  系统评价

Key words:  mycoplasma pneumoniae pneumonia  children  method of promoting blood circulation and removing blood stasis  Meta-analysis  systematic review

摘要:

目的 系统评价活血化瘀通络法治疗儿童肺炎支原体肺炎（MPP）的疗效及安全性，为临床提供循证依据。方法 计算机检索中国知网、万方、维普、中国生物医学文献数据库（CBM）、Pubmed、Embase和Cochrane Library，检索所有应用活血化瘀通络法治疗儿童MPP的临床随机对照研究，检索时限为建库至2024年9月1日。由2名研究者独立筛选文献、提取资料，并评价纳入文献的偏倚风险后，应用Review Manager 5.4软件进行Meta分析，使用Stata14.0软件进行敏感性分析。结果 最终纳入60项研究，均为随机对照研究，纳入病例数5 335例。Meta分析结果显示，与对照组相比，应用活血化瘀通络法联合西医常规治疗可有效提高MPP患儿的临床痊愈率[RR=1.51，95%CI（1.40，1.62），P＜0.000 01]，缩短完全退热天数[MD=-1.43，95%CI（-1.69，-1.16，P＜0.000 01]、咳嗽消失天数[MD=-2.08，95%CI（-2.42，-1.73），P＜0.000 01]、肺部啰音消失天数[MD=-1.97，95%CI（-2.25，-1.68），P＜0.000 01]、住院天数[MD=-1.82，95%CI（-2.07，-1.57），P＜0.000 01]；降低治疗后的C反应蛋白（CRP）[MD=-3.15，95%CI（-4.06，-2.24），P＜0.000 01]、D-二聚体[MD=-0.23，95%CI（-0.39，-0.07），P=0.005]、白细胞介素-6（IL-6）[MD=-7.97，95%CI（-8.51，-7.43），P＜0.000 01]、白细胞介素-8（IL-8）[MD=-6.24，95%CI（-7.57，-4.91），P＜0.000 01]；降低不良反应总发生率[RR=0.43，95%CI（0.30，0.62），P＜0.000 01]，差异具有统计学意义。结论 活血化瘀通络法联合西医常规治疗，可明确提高儿童MPP治疗的临床痊愈率，缩短完全退热天数、咳嗽消失天数、肺部啰音消失天数、住院天数，降低肺炎支原体肺炎患儿治疗后的CRP、IL-6、IL-8、D-二聚体水平，同时减少不良反应的总发生率。

Abstract:

Objective To systematically evaluate the efficacy and safety of promoting blood circulation and removing blood stasis in the treatment of Mycoplasma pneumoniae pneumonia(MPP) in children, so as to provide evidence-based basis for clinical practice. Methods Cnki, Wanfang, VIP, CBM, Pubmed, Embase and Cochrane Library were searched by computer to collect all randomized controlled trials(RCTS) on the application of activating blood circulation, removing blood circulation and clearing collaterals in the treatment of MPP in children. The retrieval time was from the establishment of the database to September 1, 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included literature. Review Manager 5.4 software was used for Meta-analysis, and Stata14.0 software was used for sensitivity analysis. Results A total of 60 randomized controlled trials with 5 335 patients were included. The results of Meta-analysis showed that, compared with the control group, the application of promoting blood circulation and removing blood stasis combined with conventional western medicine treatment could effectively improve the clinical cure rate of children with MPP [RR=1.51, 95%CI(1.40, 1.62), P < 0.000 01], and shorten the days of complete antipyresis [MD=-1.43, 95%CI(-1.69, -1.16, P < 0.000 01), cough disappearance days [MD=-2.08, 95%CI(-2.42, -1.73), P < 0.000 01], lung rales disa-ppearance days [MD=-1.97, 95%CI(-2.25, -1.68), P < 0.000 01] length of hospital stay [MD=-1.82, 95%CI(-2.07, -1.57), P < 0.000 01];Reduce the C-reactive protein(CRP) of after treatment(MD=-3.15, 95%CI(-4.06, -2.24), P < 0.000 01), D-dimer [MD=-0.23, 95%CI(-0.39, -0.07), P=0.005], Interleukin-6(IL-6) [MD=-7.97, 95%CI(-8.51, -7.43), P < 0.000 01], Interleukin-8(IL-8) [MD=-6.24, 95%CI(-7.57, -4.91), P < 0.000 01];The total incidence of adverse reactions was reduced [RR=0.43, 95%CI(0.30, 0.62), P < 0.000 01], and the difference was statistically significant. Conclusion Promoting blood circulation and removing blood stasis combined with conventional western medicine treatment can clearly improve the clinical cure rate of MPP in children, shorten the days of complete antipyretic, cough disappearance, lung rall disappearance and hospitalization days, reduce the levels of CRP, IL-6, IL-8 and D-dimer in children with MPP after treatment, and reduce the total incidence of adverse reactions."