中西医结合治疗耐多药肺结核随机对照试验的Meta分析  

Combined Traditional Chinese and Western Medicine Treatment for Multidrug-Resistant Pulmonary Tuberculosis: A Meta-Analysis of Randomized Controlled Trials

作　　者：金昕[1] 谢和宾[1] 曾鸿[2] 刘艳科[1] 张婷[1] 曹仕鹏[1] 尹柯[1] 

机构地区：[1]长沙市中心医院,湖南长沙410000 [2]中南大学湘雅医院,湖南长沙410004

出　　处：《中医药导报》2018年第1期84-88,95,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金："十二五"科技重大专项-艾滋病和病毒性肝炎等重大传染病防治:中药多方多途径治疗多耐药及广泛耐药肺结核临床研究与方案筛选(2013ZX10005004)

摘　　要：目的:评价中西医结合治疗耐多药肺结核的疗效和安全性。方法:计算机检索Pub Med、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、万方数据库以及维普信息资源系统中建库至2016年10月发表的中西医结合治疗耐多药肺结核的随机对照试验的研究文献。2名研究员独立按照纳入与排除标准筛选文献、提取资料及评价质量后,采用Rev Man5.3软件进行Meta分析。结果:共纳入45项研究,合计4,656例患者。Meta分析显示:治疗组痰菌阴转率[RR=1.30,95%CI(1.22,1.39),P<0.000,01]、病灶吸收率[RR=1.08,95%CI(1.01,1.14),P<0.000,01]、中医证候改善率[RR=1.23,95%CI(1.17,1.29),P<0.000,01]、空洞闭合率[RR=1.26,95%CI(1.17,1.35),P<0.000,01]以及临床综合疗效[RR=1.30,95%CI(1.21,1.39),P<0.000,01]均优于对照组,且治疗组不良事件发生率低于对照组[RR=0.65,95%CI(0.58,0.74),P<0.000,01]。结论:中西医结合治疗耐多药肺结核较单纯西药化疗安全且有效,但需要更多高质量的研究加以证实。Objective： To evaluate the effieacy and safety of combined Traditional Chinese Medicine and western medicine treatment for multidrug-resistant pulmonary tuberculosis （MDR-PTB）. Methods： We searched PubMed, CNKI, CBM, Wanfang database and Technology journal database for randomized clinieal trials （RCTs） published from inception to October 2016. Literature was screened according to inclusive and exclusive criteria, data were extracted and quality was assessed for each trial by two authors independently, and then Meta-analysis was performed using RevMan （version 5.3）. Results： There were 45 RCTs included in quantitative analysis, involving 4,656 participants with MDR-PTB in total. The results showed that combined Traditional Chinese Medicine and western medicine treatment for MDR-PTB was superior to chemotherapy alone in terms of sputum bacteriological conversion rate [RR=1.30, 95% CI（1.22,1.39）, P〈0.000,01], lung lesions resorption rate [RR=1.08, 95%CI（1.01,1.14）, P〈0.000,01], syndrome improvement rate [RR=1.23, 95%CI（1.17,1.29）, P〈0.000,01], lung cavity elosure rate [RR=1.26,95%CI（1.17,1.35）, P〈0.000,01] and total effective rate [RR=1.30, 95%CI（1.21,1.39）, P〈 0.000,01] after initiation of treatment. In addition, adverse effects of combined Traditional Chinese Medieine and western medicine treatment for MDR-PTB were less than that of chemotherapy alone [RR =0.65, 95% CI（0.58,0.74）, P〈0.000,01]. Conclusion： Combined Traditional Chinese Medicine and western medicine treatment showed beneficial effect tot MDR-PTB compared to chemotherapy alone. However, due to poor methodological reporting of the included trials, a eonfirmative conclusion needs to be supported by further robust clinical trials.

关 键 词：中西医结合 肺结核 耐多药结核病 META分析 随机对照试验 

分 类 号：R256.1[医药卫生—中医内科学]