中医针刺联合中药汤剂治疗卒中相关性肺炎疗效和安全性的Meta分析  

A Meta-analysis of the efficacy and safety of acupuncture combined with TCM decoction in the treatment of stroke-associated pneumonia

作　　者：伍新月 彭迎春 屈金玉 申学芳 熊津 曾俊杰 范安来 曾未龙 肖敏 蒋镇阳 蔺飞 肖祥 王奕力[1,2] WU Xinyue;PENG Yingchun;QU Jinyu;SHEN Xuefang;XIONG Jin;ZENG Junjie;FAN Anlai;ZENG Weilong;XIAO Min;JIANG Zhenyang;LIN Fei;XIAO Xiang;WANG Yili

机构地区：[1]成都医学院临床医学院,四川成都610083 [2]成都医学院第一附属医院,四川成都610500

出　　处：《中医临床研究》2024年第24期7-12,共6页Clinical Journal Of Chinese Medicine

基　　金：国家自然青年科学基金项目(82004461);四川省医学科研项目(S21099);成都医学院第一附属医院2021年度专项科学研究重点项目(CYFY2021ZD05);四川省大学生创新创业训练项目(202013705082);成都医学院临床医学院、第一附属医院2022年度校级研究生教育教学改革项目(YJG202204);成都市医学科研课题(2023382)。

摘　　要：目的:采用Meta分析系统评价中医针刺联合中药汤剂治疗卒中相关性肺炎(Stroke Associated-Pneumonia,SAP)的有效性与安全性。方法:互联网检索中国知网、万方、维普、Web of Science、Cochrane Library和PubMed数据库中关于中医针刺联合中药汤剂治疗SAP的随机对照试验(Randomized Controlled Trial,RCT)。按照Cochrane系统综述指南中的标准分析偏倚风险,使用RevMan 5.4软件进行Meta数据分析以及图表制作。结果:通过筛选,最终纳入8篇文献,共包括590例患者,试验组(针刺联合中药汤剂)318例、对照组(西医常规治疗)272例。Meta分析结果表明:试验组总有效率优于对照组[比值比(OR)=3.28,95%置信区间(CI)[2.03,5.30],Z=4.86,P<0.00001)];亚组分析结果显示,有效性方面:试验组能降低炎性细胞因子水平[均数差(MD)=–2.44,95%CI[–2.84,–2.03],Z=11.8,P<0.0001];提高细胞免疫功能(MD=2.20,95%CI[1.05,3.35],Z=3.74,P<0.0002);减少中医证候积分(MD=–8.19,95%CI[–14.57,–1.80],Z=2.51,P<0.01);降低临床肺部感染评分量表(Clinical Pulmonary Infection Score,CPIS)评分(MD=–0.93,95%CI[–1.71,–0.16],Z=2.37,P<0.02);症状体征改善时间方面,目前尚无数据证明试验组治疗效果显著优于对照组;安全性方面:不良反应发生率和肺部感染再发情况的Meta数据分析结果说明中医针刺联合中药汤剂的治疗方法引起的不良反应与肺部感染再发率仅与西医常规治疗疗效引起的反应相当或减少。结论:中医针刺联合中药汤剂的治疗方法有助于降低血清炎症因子水平,提高肺功能,减轻肺部感染程度,提高SAP的临床疗效,进一步减轻患者的临床症状。Objective:To evaluate the efficacy and safety of traditional Chinese medicine acupuncture combined with traditional Chinese medicine decoction in the treatment of stroke associated pneumonia using Meta-analysis systematically.Methods:Randomized controlled trials of TCM acupuncture combined with TCM decoction in the treatment of stroke-associated pneumonia were searched from CNKI,Wanfang,VIP,Web of Science,Cochrane Library and PubMed databases.The included literature was analyzed for risk of bias according to the Cochrane Manual of Systematic Reviews,Meta-analysis and graphing were made by RevMan 5.4.Results:After screening,8 studies were finally included,including a total of 590 patients,with 318 cases in the experimental group(acupuncture combined with Chinese herbal decoction)and 272 cases in the control group(conventional treatment with Western medicine).The results of Meta-analysis showed that the experimental group had better total effective rates than the control group(OR=3.28,95%CI[2.03,5.30],Z=4.86,P<0.00001).The results of subgroup analysis showed that the experimental group could reduce inflammatory cytokines(MD=–2.44,95%CI[–2.84,–2.03],Z=11.8,P<0.0001).Improve cellular immune function(MD=2.20,95%CI[1.05,3.35],Z=3.74,P<0.0002);The TCM syndrome score was reduced(MD=–8.19,95%CI[–14.57,–1.80],Z=2.51,P<0.01).CPIS score was reduced(MD=–0.93,95%CI(–1.71,–0.16),Z=2.37,P<0.02);In terms of the improvement time of symptoms and signs,there was no data to prove that the treatment effect in the experimental group was significantly better than the control group.In terms of safety:Meta data analysis on the incidence of adverse reactions and recurrence of lung infections showed that the adverse reactions and recurrence of lung infections caused by TCM acupuncture combined with TCM decoction were only comparable or reduced to those caused by conventional Western medicine treatment.Conclusion:The treatment method of acupuncture combined with TCM decoction can reduce the level of serum inflammatory facto

关 键 词：卒中相关性肺炎 针刺 中药 有效性 安全性 

分 类 号：R256.1[医药卫生—中医内科学]