流行性感冒干预措施疗效的Cochrane系统评价再评价  

Efficacy of Interventions for Treating Influenza: An Overview of Cochrane Systematic Reviews

作　　者：王瑞婷 苑艺 夏君 曹卉娟[3] WANG Ruiting;YUAN Yi;XIA Jun;CAO Huijuan(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing,100700;GRADE Center,University of Nottingham Ningbo China;International Institute of Evidence-Based Chinese Medicine,Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学东直门医院,北京市东城区100700 [2]宁波诺丁汉大学GRADE中心 [3]北京中医药大学国际循证中医药研究院

出　　处：《中医杂志》2023年第5期472-481,共10页Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局中医药创新团队及人才支持计划(ZYYCXTD-C-202006)。

摘　　要：目的 通过对现有证据的再次分析,评价流行性感冒(简称流感)的干预措施的现有证据等级及其有效性。方法 系统检索Cochrane图书馆中有关流感干预措施有效性及安全性的系统评价,检索时间为数据库建库至2021年10月31日。用AMSTAR-2量表评价纳入研究的方法学质量,运用GRADE对证据质量进行评价。结果 共纳入10篇系统评价,评价了9种干预措施,共计153项原始研究,涉及125 249例流感患者。AMSTAR-2量表评分7项研究为高质量,2项研究为中等质量,1项研究为低质量。GRADE证据评价主要结局指标中,高质量(维生素C)、中等质量(口服紫锥花制剂)证据研究各1项,其余为低或极低质量证据。主要结局指标报道情况为痊愈或痊愈率7项、死亡率1项和住院时间3项。结果提示安替威胶囊(对照为安慰剂,疗程4天,RR=3.80,95%CI为1.23~11.72,225例),感冒胶囊(对照为金刚烷胺,疗程2天,RR=5.17,95%CI为3.82~6.99,432例),不同剂量清开灵注射液(对照为林可霉素,疗程3天,每日120 ml,RR=1.41,95%CI为1.07~1.86,199例;每日160 ml,RR=1.41,95%CI为1.08~1.86,202例;每日200 ml,RR=1.52,95%CI为1.15~2.00,181例),中成药膏剂(对照为青霉素或林可霉素,疗程2天,RR=2.10,95%CI为1.20~3.67,60例)可提高流感患者痊愈率;防感颗粒(对照为对症治疗,MD=-1.24,95%CI为-1.71~-0.77,95例),葛根汤颗粒联合奥司他韦(对照为奥司他韦,MD=-0.59,95%CI为-0.76~-0.41,70例),自拟清瘟退热方联合奥司他韦(对照为奥司他韦,MD=-0.55,95%CI为-1.01~-0.09,60例)可缩短痊愈时间;痰热清联合奥司他韦(对照为奥司他韦,MD=-1.01,95%CI为-2.00~-0.02,54例)可能缩短住院时间。现有证据不支持其余干预措施可有效提高痊愈率、缩短痊愈时间或缩短住院时间,暂无可降低死亡率的干预措施。结论 维生素C、口服紫锥花制剂、非甾体类抗炎药、大蒜素胶囊在治疗流感患者时没有疗效。低和极低质量证据提示部分中药制�Objective To synthesize existing evidence on the efficacy and safety of interventions in treatment of influenza.Methodss Systematic reviews(SRs)assessing the efficacy and safety of interventions for influenza were searched from Cochrane Library from inception to October 31st,2021.AMSTAR-II was used when assessing the methodological quality of the included reviews.Grading of Recommendations Assessment,Development and Evaluation(GRADE)was used to appraise the quality of the evidence.Results A total of 153 original studies with 125249 influenza patients were included in the 10 SRs which investigated 9 interventions.Quality of the included SRs according to AMSTAR scores was categorized as“low"in one SR,“moderate"in two SRs and“high"in 7 SRs.Only two pieces of evidence were defined as high quality(Vitamin C)and moderate quality(oral echinacea preparations),while others were defined as low and very low quality according to GRADE standard.The main outcome indicators were cure or cure rate(7 reviews),mortality(1 review)and hospital stay(3 reviews).The analysis showed favorable effect of Antiwei Capsule(安替威胶囊;vs.placebo;4 days;RR=3.80,95%CI 1.23 to 11.72;225 patients),Ganmao Capsule(感冒胶囊;vs.Amantadine;2 days;RR=5.17,95%CI3.82 to 6.99;432 patients),different doses of Qingkailing Injection(清开灵注射液;vs.Lincomycin;3 days;120 ml/d:RR=1.41,95%CI 1.07 to 1.86;199 patients;160 ml/d:RR=1.41,95%CI 1.08 to 1.86;202 patients;200 ml/d:RR=1.52,95%CI 1.15 to 2.00;181 patients),herbal paste(vs.penicillin or lincomycin;2 days;RR=2.10,95%CI 1.20 to 3.67;60 patients)on increasing the cure rate.Meantime,Fanggan Granule(防感颗粒;vs.symptomatic treatment;MD=-1.24,95%CI-1.71 to-0.77;95patients),Gegen Decoction Granule(葛根汤颗粒)plus oseltamivir(vs.oseltamivir;MD=-0.59,95%CI-0.76 to-0.41;70 patients),and self-made Qingwen Tuire Formula(清瘟退热方)plus oseltamivir(vs.oseltamivir;MD=-0.55,95%CI-1.01 to-0.09;60 patients)can decrease the time to cure.Tanreqing(痰热清)combined with oseltamivir(vs.Os

关 键 词：流行性感冒 系统评价再评价 COCHRANE评价 证据图谱 META分析 

分 类 号：R511.7[医药卫生—内科学]