Department of Nursing, Nanhai Hospital of Southern Medical University, Foshan, Guangdong, China.
General Practice Center, Nanhai Hospital of Southern Medical University, Foshan, Guangdong, China.
J Altern Complement Med. 2021 Mar;27(3):225-237. doi: 10.1089/acm.2020.0310. Epub 2020 Nov 20.
Coronavirus disease 2019 (COVID-19) has become a pandemic with no specific and widely accepted effective drug or vaccine. However, studies have shown that Traditional Chinese Medicine (TCM) may play a significant role as an auxiliary treatment for COVID-19. This study aimed to assess the effects of TCM as an auxiliary treatment for COVID-19 through a systematic review of randomized-controlled trials (RCTs). Four English and three Chinese language databases were searched from December 1, 2019, to June 30, 2020. RCTs comparing TCM in combination with Western medicine (WM) with the same WM therapies alone for confirmed COVID-19 patients were included. The outcome measures were cure rate, lowering of body temperature, cough relief, improvement in chest computed tomography (CT) images, deterioration of condition, and adverse effects. Methodological quality was assessed using the Cochrane risk-of-bias tool. A series of meta-analyses were conducted for selected outcomes using RevMan 5.3 software. The quality of evidence was appraised using the grading of recommendation, assessment, development, and evaluation (GRADE) recommendations. Ten RCTs with a total of 1,285 patients were included. Compared with WM alone in treating COVID-19, WM with auxiliary treatment by TCM appears to have increased the cure rate (risk ratio [RR] 1.15 [95% confidence interval (CI) 1.04-1.26]), relieved cough (RR 1.32 [95% CI 1.15-1.52]), improved chest CT images (RR 1.23 [95% CI 1.11-1.37]), and reduced the number of cases transitioning from a moderate to severe condition (RR 0.58 [95% CI 0.43-0.77]). The authors are uncertain whether TCM combined WM has effects on fever normalization (RR 1.10 [95% CI 0.94-1.29]) or adverse effects (RR 0.81 (95% CI 0.42-1.57]). Although they evaluated the certainty of evidence for lowering body temperature and adverse effects as very low, and low for cure rate, certainty was evaluated as moderate for improvement in chest CT images, cough relief, and deterioration of condition. TCM may be an effective auxiliary treatment for COVID-19 patients, which is likely to help improve the main symptoms and reduce disease progression. However, due to the limited number of studies and apparent heterogeneity among them, a more definitive conclusion on the effect of TCM on lowering body temperature and adverse effects cannot be drawn at this time.
新型冠状病毒肺炎（COVID-19）已成为一种大流行疾病，目前尚无特效药物和广泛认可的疫苗。然而，研究表明，中药（TCM）可能在辅助治疗 COVID-19 方面发挥重要作用。本研究旨在通过系统评价随机对照试验（RCT）来评估 TCM 作为 COVID-19 辅助治疗的效果。从 2019 年 12 月 1 日至 2020 年 6 月 30 日，检索了四个英文数据库和三个中文数据库。纳入比较 TCM 联合西药（WM）与 WM 单一疗法治疗确诊 COVID-19 患者的 RCT。结局指标为治愈率、体温降低、咳嗽缓解、胸部计算机断层扫描（CT）图像改善、病情恶化和不良反应。采用 Cochrane 偏倚风险工具评估方法学质量。使用 RevMan 5.3 软件对选定结局进行了一系列荟萃分析。使用推荐、评估、发展和评估（GRADE）建议评估证据质量。纳入了 10 项 RCT，共 1285 例患者。与 WM 单独治疗 COVID-19 相比，WM 联合 TCM 辅助治疗似乎提高了治愈率（风险比[RR]1.15[95%置信区间（CI）1.04-1.26]）、缓解咳嗽（RR 1.32[95% CI 1.15-1.52]）、改善胸部 CT 图像（RR 1.23[95% CI 1.11-1.37]）和减少从中度转为重度的病例数（RR 0.58[95% CI 0.43-0.77]）。作者不确定 TCM 联合 WM 是否对体温正常化（RR 1.10[95% CI 0.94-1.29]）或不良反应（RR 0.81[95% CI 0.42-1.57]）有影响。尽管他们将降低体温和不良反应的证据确定性评估为非常低和低，将治愈率的证据确定性评估为中，但对胸部 CT 图像、咳嗽缓解和病情恶化的证据确定性评估为中。TCM 可能是 COVID-19 患者的一种有效辅助治疗方法，可能有助于改善主要症状并减缓疾病进展。然而，由于研究数量有限且存在明显异质性，目前尚不能得出 TCM 对降低体温和不良反应影响的确切结论。
