The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences, And the Second Clinical College of Guangzhou University of Chinese Medicine, 111 Da De Road, Guangzhou, 510120, China.
The Second Clinical College of Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510000, China.
J Ethnopharmacol. 2022 Jun 28;292:115043. doi: 10.1016/j.jep.2022.115043. Epub 2022 Feb 4.
Qingkailing (QKL), Reduning (RDN), Xiyanping (XYP), Tanreqing (TRQ) and Yuxingcao (YXC) injections are all phlegm-heat clearing Chinese medicine (CM) injections composed of the extract from traditional CM materials. Evidence from clinical studies and animal experiments indicates that the above CM injections are effective supplementary therapy for acute exacerbation chronic obstructive pulmonary disease (AECOPD), and clinicians are faced with a difficult choice on the optimal phlegm-heat clearing CM injection for AECOPD.
This systematic review and Bayesian network meta-analysis aimed to evaluate the comparative effectiveness of five commonly used phlegm-heat clearing CM injections for COPD.
A pairwise and network meta-analyses were performed to assess the effectiveness of QKL, RDN, TRQ, XYP and YXC on AECOPD. Randomized controlled trials (RCTs) were identified by searching English and Chinese databases. The primary outcome was lung function (forced expiration volume [FEV1] and forced vital capacity [FVC]), blood gas analysis index was secondary outcome measure. Winbugs and Stata 15.0 software were used for data analysis.
A total of 57 RCTs were included. The pairwise analyses showed that each of the injections combined with routine treatment were superior to routine treatment alone [FEV1: QKL, MD 0.20, 95% CI (0.06, 0.35); RDN, MD 0.24, 95% CI (0.08, 0.40); TRQ, MD 0.24, 95% CI (0.19, 0.29); XYP, MD 0.26, 95% CI (0.20, 0.32); YXC MD 0.73, 95% CI (0.06, 1.41)]. The network meta-analysis provided the following rank of lung function improvement: FEV1: YXC > TRQ > XYP > RDN > QKL; FVC: YXC > TRQ > QKL > RDN > XYP. RDN and YXC ranked highest in blood gas analysis index. RDN was the highest ranked injection for effectiveness, followed by QKL, TRQ, XYP, then YXC. Most of the injections appeared safe, with severe adverse events rarely reported.
This study suggests that YXC and TRQ are the most effective therapies in treating AECOPD patients. RDN and YXC are more effective in the alleviation of clinical symptoms. Given that the safety of YXC is controversial, TRQ and RDN may be preferable as phlegm-heat clearing CM injections in the adjuvant treatment of AECOPD.
清开灵（QKL）、热毒宁（RDN）、喜炎平（XYP）、痰热清（TRQ）和鱼腥草（YXC）注射液均为具有清热化痰功效的中药（CM）注射液，由传统 CM 材料的提取物组成。临床研究和动物实验的证据表明，上述 CM 注射液对急性加重期慢性阻塞性肺疾病（AECOPD）是有效的辅助治疗方法，临床医生在选择治疗 AECOPD 的最佳清热化痰 CM 注射液时面临着困难的选择。
本系统评价和贝叶斯网络荟萃分析旨在评估五种常用清热化痰 CM 注射液治疗 COPD 的比较疗效。
采用配对和网络荟萃分析评估 QKL、RDN、TRQ、XYP 和 YXC 对 AECOPD 的疗效。通过检索英文和中文数据库来确定随机对照试验（RCT）。主要结局指标为肺功能（用力呼气量 [FEV1] 和用力肺活量 [FVC]），血气分析指标为次要结局指标。使用 Winbugs 和 Stata 15.0 软件进行数据分析。
共纳入 57 项 RCT。配对分析显示，与常规治疗相比，每种注射液联合常规治疗均优于常规治疗单独治疗[FEV1：QKL，MD 0.20，95%CI（0.06，0.35）；RDN，MD 0.24，95%CI（0.08，0.40）；TRQ，MD 0.24，95%CI（0.19，0.29）；XYP，MD 0.26，95%CI（0.20，0.32）；YXC，MD 0.73，95%CI（0.06，1.41）]。网络荟萃分析提供了改善肺功能的排名如下：FEV1：YXC＞TRQ＞XYP＞RDN＞QKL；FVC：YXC＞TRQ＞QKL＞RDN＞XYP。在血气分析指标方面，RDN 和 YXC 排名最高。在疗效方面，RDN 排名最高，其次是 QKL、TRQ、XYP 和 YXC。大多数注射液似乎是安全的，很少有严重的不良事件报告。
本研究表明，YXC 和 TRQ 是治疗 AECOPD 患者最有效的治疗方法。RDN 和 YXC 更能有效缓解临床症状。鉴于 YXC 的安全性存在争议，TRQ 和 RDN 可能是治疗 AECOPD 的辅助治疗中更可取的清热化痰 CM 注射液。
