Ji Zhao-Chen, Qiang Xiao-Yu, Hu Hai-Yin, Chen Zhe, Ou Yi, Feng Chao-Nan, Cao Lu-Jia, Zhang Jun-Hua
Center for Evidence-based Medicine, Tianjin University of Traditional Chinese Medicine Tianjin 301617, China.
Zhongguo Zhong Yao Za Zhi. 2022 May;47(9):2343-2350. doi: 10.19540/j.cnki.cjcmm.20210913.501.
The present study reviewed the clinical randomized controlled trials(RCTs) of Chinese patent medicine for pneumonia to provide references for clinical research, guideline development, and policy formulation, and promote the quality improvement of clinical evidence. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, Wanfang, SinoMed were searched for RCTs of Chinese patent medicine for pneumonia from database inception to December 31, 2019. A total of 1 245 RCTs were included, involving 84 Chinese patent medicines, including 45 oral medicines and 39 injections. Specifically, 85.9% of RCTs had treatment course not exceeding 14 d; 43.3% of RCTs had a sample size of more than 100 cases and 6.1% of RCTs more than 200 cases; 13 types of interventions/controls were included in the RCTs, with Chinese patent medicine + western medicine vs western medicine as the top one used(32.6%). In outcome indicators, symptoms/signs(3 285) and physicochemical detection(2 066) were the most frequently applied. In the methodological evaluation, "allocation concealment" was not clearly described or mentioned in 71.2% of RCTs, and "blinding" in 23.9% of RCTs met the normative standards. Registration and research ethics were not clearly reported. There are many methodological deficiencies in terms of design and implementation in included RCTs, which may impact the reliability and practicability of the results of RCTs. Additionally, key standards were unclear(such as disease classification methods and selection of core outcome indicators). In conclusion, RCTs should give priority to the preciseness and scientificity of the protocol, strengthening quality control of the processes and accelerating the standardized research of key links.
本研究回顾了中成药治疗肺炎的临床随机对照试验(RCT),为临床研究、指南制定和政策制定提供参考,促进临床证据质量的提高。在中医药临床证据数据库系统(EVDS)收集的基础上,检索中国知网(CNKI)、万方、中国生物医学文献数据库(SinoMed)中自建库至2019年12月31日关于中成药治疗肺炎的RCT。共纳入1245项RCT,涉及84种中成药,其中口服制剂45种,注射剂39种。具体而言,85.9%的RCT疗程不超过14天;43.3%的RCT样本量超过100例,6.1%的RCT样本量超过200例;RCT纳入了13种干预措施/对照,其中中成药+西药对比西药使用最为频繁(32.6%)。在结局指标方面,症状/体征(3285项)和理化检测(2066项)应用最为频繁。在方法学评价中,71.2%的RCT未明确描述或提及“分配隐藏”,23.9%的RCT“盲法”符合规范标准。注册和研究伦理未明确报告。纳入的RCT在设计和实施方面存在诸多方法学缺陷,可能影响RCT结果的可靠性和实用性。此外,关键标准不明确(如疾病分类方法和核心结局指标的选择)。总之,RCT应优先考虑方案的精确性和科学性,加强过程质量控制,加快关键环节的规范化研究。