中药与西医联合治疗2019冠状病毒病：系统评价与荟萃分析
Combination of Chinese herbal medicine and conventional western medicine for coronavirus disease 2019: a systematic review and meta-analysis.
作者信息
Tong Lei, Ma Zhenyu, Zhou Yixiao, Yang Shuping, Yang Yalin, Luo Jingran, Huang Junbo, Wang Fucai
机构信息
School of Medicine, Huaqiao University, Quanzhou, China.
出版信息
Front Med (Lausanne). 2023 Jul 17;10:1175827. doi: 10.3389/fmed.2023.1175827. eCollection 2023.
OBJECTIVE
This study aimed to assess the efficacy and safety of Chinese herbal medicine (CHM) plus conventional western medicine (CWM) in comparison with CWM against COVID-19.
METHODS
We searched eight electronic databases and three trial registers spanning from January 1, 2020 to May 18, 2023. We included randomized controlled trials (RCTs) comparing the effectiveness and safety of CHM plus CWM and CWM against COVID-19 in our study. The Cochrane Risk of Bias tool 2.0 (RoB2) was applied to evaluate the methodological quality of the included RCTs. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was employed to assess the certainty of evidence. Statistical analysis was implemented in R version 4.1.2.
RESULTS
Our study included 50 RCTs involving 11,624 patients. In comparison with sole CWM, CHM plus CWM against COVID-19 significantly enhanced clinical effective rate (RR = 1.18, 95% CI [1.13, 1.22]), improved chest image (RR = 1.19, 95% CI [1.11, 1.28]), inhibited clinical deterioration (RR = 0.45, 95% CI [0.33, 0.60]), lowered mortality (RR = 0.53, 95% CI [0.40, 0.70]), and reduced the total score of TCM syndrome (SMD = -1.24, 95% CI [-1.82, -0.66]). SARS-CoV-2 nucleic acid conversion time (MD = -2.66, 95% CI [-3.88, -1.44]), duration of hospitalization (MD = -2.36, 95% CI [-3.89, -0.82]), and clinical symptom (fever, cough, fatigue, and shortness of breath) recovery times were shorter in CHM plus CWM groups than in CWM groups. Further, CHM plus CWM treatment was more conducive for some laboratory indicators returning to normal levels. No statistical difference was found in the incidence of total adverse reactions between the two groups (RR = 0.97, 95% CI [0.88, 1.07]). We assessed the risk of bias for 246 outcomes, and categorized 55 into "low risk", 151 into "some concerns", and 40 into "high risk". Overall, the certainty of the evidence ranged from moderate to very low.
CONCLUSIONS
Potentially, CHM listed in this study, as an adjunctive therapy, combining with CWM is an effective and safe therapy mode for COVID-19. However, more high-quality RCTs are needed to draw more accurate conclusions.
CLINICAL TRIAL REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=293963.
目的
本研究旨在评估中药加西药与单纯西药相比治疗新型冠状病毒肺炎（COVID-19）的疗效和安全性。
方法
我们检索了8个电子数据库和3个试验注册库，检索时间跨度为2020年1月1日至2023年5月18日。我们纳入了比较中药加西药与单纯西药治疗COVID-19有效性和安全性的随机对照试验（RCT）。采用Cochrane偏倚风险工具2.0（RoB2）评估纳入RCT的方法学质量。采用推荐分级、评估、制定与评价（GRADE）系统评估证据的确定性。在R 4.1.2版本中进行统计分析。
结果
我们的研究纳入了50项RCT，涉及11624例患者。与单纯西药相比，中药加西药治疗COVID-19显著提高了临床有效率（RR = 1.18，95%CI [1.13, 1.22]），改善了胸部影像（RR = 1.19，95%CI [1.11, 1.28]），抑制了临床恶化（RR = 0.45，95%CI [0.33, 0.60]），降低了死亡率（RR = 0.53，95%CI [0.40, 0.70]），并降低了中医证候总分（SMD = -1.24，95%CI [-1.82, -0.66]）。中药加西药组的新型冠状病毒2（SARS-CoV-2）核酸转阴时间（MD = -2.66，95%CI [-3.88, -1.44]）、住院时间（MD = -2.36，95%CI [-3.89, -0.82]）以及临床症状（发热、咳嗽、乏力和气短）恢复时间均短于单纯西药组。此外，中药加西药治疗更有利于一些实验室指标恢复至正常水平。两组间总不良反应发生率无统计学差异（RR = 0.97，95%CI [0.88, 1.07]）。我们评估了246个结局的偏倚风险，将55个结局分类为“低风险”，151个结局分类为“有一些担忧”，40个结局分类为“高风险”。总体而言，证据的确定性从中等到非常低不等。
结论
本研究中的中药作为辅助治疗与西药联合使用，可能是一种治疗COVID-19的有效且安全的治疗模式。然而，需要更多高质量的RCT来得出更准确的结论。
临床试验注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=293963 。
Zotero 插件