Huang Xinggui, Tao Sian, Liu Chenhao, Sun Xiaoluo, Hao Yule, Ma Yuqi, Liu Yi, Liu Jibin
School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Pharmacol. 2024 Sep 24;15:1378445. doi: 10.3389/fphar.2024.1378445. eCollection 2024.
pneumonia (MPP) is the predominant community-acquired pneumonia (CAP) in children aged 5 years or older. In recent decades, the annual increase in drug resistance rates of macrolide antibiotics, particularly azithromycin (AZ), has led to complex clinical treatment strategies and substantial healthcare costs associated with MPP. Chinese medicine injections (CMIs), recognized as an effective supplementary therapy, are acknowledged by clinicians in China. It is necessary to explore the efficacy of azithromycin in combination with CMIs.
Randomized controlled trials (RCTs) evaluating azithromycin in combination with seven types of CMIs for MPP in children were identified based on inclusion criteria and assessed using the revised Cochrane risk of bias tool (RoB 2.0). R 4.3.1 and STATA 15.0 were employed to generate ranking probabilities and perform network meta-analysis. Competing interventions were ranked using the surface under the cumulative ranking (SUCRA) probabilities.
A comprehensive analysis was performed on 155 RCTs involving 15,014 patients and 8 therapeutic strategies within this Bayesian network meta-analysis (BNMA). The results indicated that AZ combined with seven types of CMIs was more effective than azithromycin alone in overall outcomes. Notably, azithromycin combined with Chuanhuning injection (AZ + CHN) achieved the highest ranking in improving the clinical effectiveness rate (SUCRA, 80.89%); regarding secondary outcome measures, azithromycin combined with Yanhuning injection (AZ + YHN) had the highest probability of improving four different outcomes: disappearance time of cough (SUCRA, 80.01%), disappearance time of pulmonary rale (SUCRA, 87.77%), disappearance time of fever (SUCRA, 95.70%), and disappearance time of pulmonary shadows in -ray (SUCRA, 97.34%); furthermore, azithromycin combined with Qingkailing injection (AZ + QKL) was more likely to reduce average hospitalization time (SUCRA, 94.60%).
This study highlights the potential benefits of seven types of Chinese medicine injections as adjunctive therapy for pneumonia in children. However, further support and validation of these findings are needed through high-quality randomized controlled trials with larger sample sizes and double-blind designs.
肺炎支原体肺炎（MPP）是5岁及以上儿童社区获得性肺炎（CAP）的主要类型。近几十年来，大环内酯类抗生素尤其是阿奇霉素（AZ）耐药率逐年上升，导致MPP临床治疗策略复杂且医疗成本高昂。中药注射剂（CMIs）作为一种有效的辅助治疗方法，在中国得到临床医生的认可。有必要探讨阿奇霉素联合CMIs的疗效。
根据纳入标准确定评估阿奇霉素联合七种CMIs治疗儿童MPP的随机对照试验（RCTs），并使用修订后的Cochrane偏倚风险工具（RoB 2.0）进行评估。使用R 4.3.1和STATA 15.0生成排序概率并进行网络荟萃分析。使用累积排序曲线下面积（SUCRA）概率对竞争性干预措施进行排序。
在这项贝叶斯网络荟萃分析（BNMA）中，对涉及15014例患者和8种治疗策略的155项RCTs进行了综合分析。结果表明，AZ联合七种CMIs在总体疗效上比单用阿奇霉素更有效。值得注意的是，阿奇霉素联合穿琥宁注射液（AZ + CHN）在提高临床有效率方面排名最高（SUCRA，80.89%）；在次要结局指标方面，阿奇霉素联合炎琥宁注射液（AZ + YHN）在改善四项不同结局方面概率最高：咳嗽消失时间（SUCRA，80.01%）、肺部啰音消失时间（SUCRA，87.77%）、发热消失时间（SUCRA，95.70%）和胸部X线肺部阴影消失时间（SUCRA，97.34%）；此外，阿奇霉素联合清开灵注射液（AZ + QKL）更有可能缩短平均住院时间（SUCRA，94.60%）。
本研究强调了七种中药注射剂作为儿童肺炎支原体肺炎辅助治疗的潜在益处。然而，需要通过样本量更大、双盲设计的高质量随机对照试验来进一步支持和验证这些发现。
