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[2019年冠状病毒病的中医临床研究方案分析]

[Analysis on clinical study protocols of traditional Chinese medicine for coronavirus disease 2019].

作者信息

Wang Hui, Jin Xin-Yao, Pang Bo, Liu Chun-Xiang, Zheng Wen-Ke, Yang Feng-Wen, Pang Wen-Tai, Zhang Jun-Hua

机构信息

Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine Tianjin 301617, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2020 Mar;45(6):1232-1241. doi: 10.19540/j.cnki.cjcmm.20200220.501.

Abstract

To analyze the registered clinical trial protocols of traditional Chinese medicine(TCM) for the prevention and treatment of coronavirus disease 2019(COVID-19), in order to provide information for improving the quality of research design. The website of the Chinese Clinical Trial Registry(www.chictr.org.cn) and the American Clinical Trial Registry(clinicaltrials.gov) were searched to collect protocols of TCM for COVID-19. Documents were screened following the inclusion criteria, and data were extracted in regard to registration date, study objective, type of design, sponsor, patient, sample size, intervention, and evaluation index. Descriptive analysis was conducted. A total of 49 clinical trial protocols of TCM for COVID-19 were included. Primary sponsors were mainly hospitals or universities in places like Hubei, Beijing, Zhejiang and other regions. The implementation units are mainly in Hubei, Guangdong, Zhejiang, Henan and other regional hospitals. The types of study design were mainly experimental studies(40), including 30 randomized parallel controlled trials, 7 non-randomized controlled trials, 2 single arm trials and 1 consecutively recruited trial; besides, there were also 6 observational studies, 2 health service studies and 1 preventive study. The sample size reached a total of 30 562 cases, with a maximum of 20 000 for a single study and a minimum of 30. The 49 trials subjects included healthy people(3), isolation and observation cases(1), suspected cases(10),confirmed COVID-19 patients(31) and COVID-19 recovery patients(4). Of the 31 trials planned to include confirmed COVID-19 patients, 16 protocols no definite disease classification, 3 with a clear exclusion of severe subjects, 4 with common subjects, 2 with light, common or severe subjects, 1 with light and common subjects, 1 with common or severe subjects, 3 with severe subjects, and 1 with severe or critical subjects. The experimental interventions included Chinese patent medicine(Lianhua Qingwen Capsules/Granules, Huoxiang Zhengqi Dropping Pills/Oral Liquid, Babao Dan, Gubiao Jiedu Ling, Jinhao Jiere Granules, Compound Yu-xingcao Mixture, Jinye Baidu Granules, Shufeng Jiedu Capsuless, Shuanghuanglian Oral Liquid, Tanreqing Injection, Xuebijing Injection, Reduning Injection, Xiyanping Injection), Chinese medicinal decoction and taichi. The primary evaluation outcomes mainly included antipyretic time, clinical symptom relief, novel coronavirus nucleic acid turning to negative, conversion rate of severe cases and chest CT. There was a quick response of clinical research on the prevention and treatment of COVID-19 with TCM, with the current registered protocols covers the whole process of disease prevention, treatment and rehabilitation. However, issues need to be concerned, including unclear definition of patient's condition, unclear research objectives, unclear intervention process and inappropriate outcomes, etc. In addition, researchers should consider the actual difficulties and workload of doctors in epidemic response environment, and make effort to optimize the process and improve the operability of research protocols under the principle of medical ethics.

摘要

分析已注册的中医药防治新型冠状病毒肺炎(COVID-19)的临床试验方案,为提高研究设计质量提供信息。检索中国临床试验注册中心网站(www.chictr.org.cn)和美国临床试验注册中心(clinicaltrials.gov),收集中医药防治COVID-19的试验方案。按照纳入标准筛选文献,并提取注册日期、研究目的、设计类型、申办者、患者、样本量、干预措施及评价指标等数据,进行描述性分析。共纳入49项中医药防治COVID-19的临床试验方案。主要申办者主要是湖北、北京、浙江等地区的医院或高校。实施单位主要是湖北、广东、浙江、河南等地区的医院。研究设计类型主要为实验性研究(40项),包括30项随机平行对照试验、7项非随机对照试验、2项单臂试验和1项连续招募试验;此外,还有6项观察性研究、2项卫生服务研究和1项预防性研究。样本量共计30562例,单个研究最多20000例,最少30例。49项试验的受试者包括健康人(3例)、隔离观察病例(1例)、疑似病例(10例)、确诊COVID-19患者(31例)和COVID-19康复患者(4例)。在计划纳入确诊COVID-19患者的31项试验中,16项方案对疾病分类不明确,3项明确排除重症受试者,4项为普通受试者,2项为轻型、普通型或重型受试者,1项为轻型和普通型受试者,1项为普通型或重型受试者,3项为重型受试者,1项为重型或危重型受试者。实验性干预措施包括中成药(连花清瘟胶囊/颗粒、藿香正气滴丸/口服液、八宝丹、固表解毒灵、金浩解热颗粒、复方鱼腥草合剂、金叶败毒颗粒、疏风解毒胶囊、双黄连口服液、痰热清注射液、血必净注射液、热毒宁注射液、喜炎平注射液)、中药汤剂和太极拳。主要评价指标主要包括退热时间、临床症状缓解情况、新型冠状病毒核酸转阴情况、重症转化率及胸部CT。中医药防治COVID-19的临床研究响应迅速,目前已注册的方案涵盖了疾病预防、治疗及康复的全过程。然而,仍有一些问题需要关注,包括患者病情定义不明确、研究目的不清晰、干预过程不明确及结局指标不恰当等。此外,研究者应考虑医生在疫情应对环境中的实际困难和工作量,并在医学伦理原则下努力优化研究流程,提高研究方案的可操作性。

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