黄芪辅助治疗肺结核效果的系统评价  

Effects of Astragaulus Membranaceus on Pulmonary Tuberculosis:A Systematic Review

作　　者：高鹏[1] 肖萍[1] 陈青锋[1] 杨彦麟[1] 赵桂玲[2] 王立明[1] 周萍[1] 何强[1] 魏喜生[1] 

机构地区：[1]兰州大学第一医院传染病研究室,兰州730000 [2]兰州大学第一医院肾病科,兰州730000

出　　处：《中国循证医学杂志》2011年第6期698-705,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价黄芪(Astragaulus membranaceus)辅助治疗肺结核的疗效。方法应用Cochrane协作网系统评价的方法,计算机检索Cochrane Library(2010年第3期)、CNKI(1991～2010.5)、VIP(1989～2010.5)、EMbase(1981～2010.5)以及PubMed(1981～2010.5)中黄芪辅助治疗肺结核的随机和半随机对照试验。由两位研究者对符合纳入标准的试验进行独立筛选、资料提取和质量评价,并交叉核对,而后采用RevMan 5.0软件进行Meta分析。结果最终纳入12个随机对照试验,共1 054例肺结核患者,试验地点均在中国大陆。Meta分析结果显示:①黄芪可有效辅助常规抗结核药物治疗肺结核,促进患者痰菌阴转,肺部病变吸收以及肺部空洞的吸收;②黄芪可有效降低常规抗结核药物的不良反应;③黄芪与常规抗结核药物联用,可使患者的症状和体征显著改善;④随访发现黄芪+常规药物治疗可使肺结核患者的细菌学复发率有显著下降。结论现有证据表明,黄芪治疗肺结核有一定的疗效且相对安全。但由于本系统评价纳入研究的样本量较小且方法学质量低下,现有证据尚不足以推荐临床常规应用黄芪辅助治疗肺结核。对上述结果,尚需开展更多高质量的多中心、大样本、且随访时间足够的随机双盲对照试验加以验证。To assess the effect of astragaulus membranaceus in the treatment of pulmonary tuberculosis. Methods Through applying the methods provided by the Cochrane Collaboration, the randomized controlled trials （RCTs） or quasi-RCTs of astragaulus membranaceus in the treatment of pulmonary tuberculosis were searched in The Cochrane Library （Issue 3, 2010）, CNKI （1991 to May 2010）, VIP （1989 to May 2010）, EMbase （1981 to May 2010）, and PubMed （1981 to May 2010）. Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross checked then. The RevMan 5.0 software was used to conduct meta-analyses. Results Twelve RCTs involving 1 054 patients were included. All trials were tested in the China's Mainland. The results of meta-analyses showed that： a） The astragaulus membranaceus could assist the conventional drug to cure pulmonary tuberculosis, promote sputum negative conversion, focal absorption and cavity reduction in lung; b） The astragaulus membranaceus could reduce the adverse reactions of the conventional drug; c） The astragaulus membranaceus combined with the conventional drug could improve the patients＇ symptoms and signs; and d） The astragaulus membranaceus combined with the conventional drug could reduce the bacterial relapse rates in follow-up after treatment. Conclusion The current evidence shows that the astragaulus membranaceus has some effects and is relatively safe to treat pulmonary tuberculosis. However, it is far from enough to recommend astragaulus membranaceus as a conventional adjuvant therapy for pulmonary tuberculosis because of no sufficient evidence obtained from this study for its small sample and low methodology quality. Therefore, more double-blind multi-center RCTs with high quality, large sample, and adequate follow up are required for further verification.

关 键 词：黄芪 肺结核 系统评价 META分析 随机对照试验 

分 类 号：R259[医药卫生—中西医结合]