Li Pochen, Wu Yang, Ge Danxia, Xu Ruyi, Zhang Qianping, Li Yujiao, Zhang Lingyao, Peng HsuanChieh, Yu Fangyu
Intensive Care Unit, Ningbo Municipal Hospital of Traditional Chinese Medicine (TCM), Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, China.
Department of Respiratory, Ningbo Municipal Hospital of Traditional Chinese Medicine (TCM), Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, China.
Front Pharmacol. 2025 Mar 7;16:1545088. doi: 10.3389/fphar.2025.1545088. eCollection 2025.
Ventilator-associated pneumonia (VAP) frequently results in difficulties with weaning, high mortality rates, and is often caused by drug-resistant pathogens, emphasizing the critical importance of effective treatment. The efficacy and safety of Tanreqing injection (TRQI) in the treatment of VAP patients have been demonstrated, but further validation is required. The objective of this study is to synthesize the findings of clinical research on TRQI for the treatment of VAP, thereby providing clinical evidence for its effectiveness and importance.
A comprehensive search of eight databases was conducted, covering all records up to 30 August 2024. The data were extracted, quality-assessed, and analyzed rigorously. The methodological quality of the included studies was evaluated using the RoB-2 tool. The statistical analyses were conducted using RevMan 5.4 software, with either a fixed-effect or random-effect model employed as appropriate. The evidence quality of the included literature was evaluated using Grade pro 3.6.1 software.
A total of 20 clinical studies, comprising a total of 1,446 patients, were included in the review. The meta-analysis of these studies demonstrated that TRQI significantly improved inflammatory markers (CRP, PCT, WBC) ( < 0.00001) and reduced the duration of antibiotic use ( < 0.00001). Furthermore, the intervention resulted in a shorter duration of ventilator usage ( < 0.0001), an increased initial weaning success rate ( = 0.001), and a reduction in the length of stay in the intensive care unit (ICU) ( < 0.00001). Furthermore, the TRQI demonstrated superior performance compared to the control group in CPIS (Clinical Pulmonary Infection Score) assessments ( 0.00001). Meanwhile, the quality of evidence for CRP, PCT, Duration of Antibiotic Use, Duration of Ventilator Use, and Length of ICU Stay is Moderate.
This study provides further evidence-based support for the clinical application of TRQI in the treatment of VAP. Additionally, it summarizes previous clinical research through a literature quality assessment, offering insights and recommendations for the design and implementation of future research protocols. The findings indicate that TRQI can improve inflammatory markers and pulmonary infection scores in VAP patients, reduce ventilator dependence, and shorten antibiotic use duration. Moreover, it has a low overall incidence of adverse reactions, demonstrating good efficacy and safety as an adjuvant therapy for VAP. However, some of the included clinical studies had limitations such as small sample sizes, lack of sample size calculations. Therefore, future study designs should be more rigorous to enhance the reliability of findings.
呼吸机相关性肺炎（VAP）常常导致撤机困难、死亡率高，且常由耐药病原体引起，这凸显了有效治疗的至关重要性。痰热清注射液（TRQI）治疗VAP患者的疗效和安全性已得到证实，但仍需进一步验证。本研究的目的是综合TRQI治疗VAP的临床研究结果，从而为其有效性和重要性提供临床证据。
对八个数据库进行全面检索，涵盖截至2024年8月30日的所有记录。对数据进行严格提取、质量评估和分析。使用RoB-2工具评估纳入研究的方法学质量。采用RevMan 5.4软件进行统计分析，根据情况采用固定效应或随机效应模型。使用Grade pro 3.6.1软件评估纳入文献的证据质量。
本综述共纳入20项临床研究，总计1446例患者。这些研究的荟萃分析表明，TRQI显著改善了炎症标志物（CRP、PCT、WBC）（<0.00001），并缩短了抗生素使用时长（<0.00001）。此外，该干预措施使呼吸机使用时长缩短（<0.0001），初始撤机成功率提高（=0.001），重症监护病房（ICU）住院时长缩短（<0.00001）。此外，在临床肺部感染评分（CPIS）评估中，TRQI表现优于对照组（<0.00001）。同时，CRP、PCT、抗生素使用时长、呼吸机使用时长和ICU住院时长的证据质量为中等。
本研究为TRQI在VAP治疗中的临床应用提供了进一步的循证支持。此外，它通过文献质量评估总结了既往临床研究，为未来研究方案的设计和实施提供了见解和建议。研究结果表明，TRQI可改善VAP患者的炎症标志物和肺部感染评分，降低呼吸机依赖程度，缩短抗生素使用时长。此外，其不良反应总体发生率较低，作为VAP的辅助治疗显示出良好的疗效和安全性。然而，部分纳入的临床研究存在局限性，如样本量小、缺乏样本量计算等。因此，未来的研究设计应更加严谨，以提高研究结果的可靠性。
