基于网状Meta分析比较4种中药注射液联合常规治疗对支气管肺炎患儿临床总有效率、体温恢复时间、咳嗽消失时间、肺部啰音消失时间、喘憋缓解时间、肺部阴影消失时间的影响，评价4种中药注射液治疗儿童支气管肺炎的安全性，为儿童支气管肺炎的临床用药提供循证依据。计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、EMbase、Web of Science、Cochrane Library数据库中药注射液治疗儿童支气管肺炎的随机对照试验(RCT)，检索时限为各数据库建库至2024年1月2日，提取合格文献的相关信息，采用R 4。2。3、Stata 15软件进行数据分析，通过Cochrane风险偏倚评价工具对纳入文献进行质量评价。最终纳入70篇RCTs，样本量8 629例，试验组4 296例，对照组4 333例，涉及4种中药注射液(痰热清注射液、热毒宁注射液、喜炎平注射液、炎琥宁注射液)。网状Meta分析显示:①提高临床总有效率方面，累计概率排名曲线下面积(SUCRA)排序为喜炎平注射液+常规治疗＞痰热清注射液+常规治疗＞热毒宁注射液+常规治疗＞炎琥宁注射液+常规治疗＞常规治疗;②缩短体温恢复时间方面，SUCRA排序为炎琥宁注射液+常规治疗＞喜炎平注射液+常规治疗＞热毒宁注射液+常规治疗＞痰热清注射液+常规治疗＞常规治疗;③缩短咳嗽消失时间方面，SUCRA排序为炎琥宁注射液+常规治疗＞喜炎平注射液+常规治疗＞热毒宁注射液+常规治疗＞痰热清注射液+常规治疗＞常规治疗;④缩短肺部啰音消失时间方面，SUCRA排序为喜炎平注射液+常规治疗＞热毒宁注射液+常规治疗＞炎琥宁注射液+常规治疗＞痰热清注射液+常规治疗＞常规治疗;⑤缩短喘憋缓解时间方面，SUCRA排序为喜炎平注射液+常规治疗＞痰热清注射液+常规治疗＞炎琥宁注射液+常规治疗＞热毒宁注射液+常规治疗＞常规治疗;⑥缩短肺部阴影消失时间方面，SUCRA排序为热毒宁注射液+常规治疗＞炎琥宁注射液+常规治疗＞痰热清注射液+常规治疗＞喜炎平注射液+常规治疗＞常规治疗;⑦安全性方面，42篇RCTs报告了不良反应的发生情况，主要表现为胃肠道反应和皮疹。当前证据显示，4种中药注射液联合常规治疗对儿童支气管肺炎均有效，且各有侧重。在提高临床总有效率、缩短肺部啰音消失时间与喘憋缓解时间方面，喜炎平注射液+常规治疗的疗效可能最佳;在缩短体温恢复时间与咳嗽消失时间方面，炎琥宁注射液+常规治疗的疗效可能最佳;在缩短肺部阴影消失时间方面，热毒宁注射液+常规治疗的疗效可能最佳。试验组与对照组在治疗期间均未出现严重的药物不良反应。受纳入文献质量与数量的限制，上述结论有待更多设计严谨且高质量的RCT进一步验证。
Network Meta-analysis of four traditional Chinese medicine injections combined with conventional western medicine in treatment of bronchopneumonia in children
Based on network Meta-analysis,we compared the effects of four traditional Chinese medicine(TCM)injections com-bined with conventional treatment on clinical total effective rate,recovery time of body temperature,cough disappearance time,lung rale disappearance time,wheezing relief time,and lung shadow disappearance time of bronchopneumonia in children and evaluated the safety of the four TCM injections in the treatment of bronchopneumonia in children,so as to provide an evidence-based basis for the clinical use of medication for bronchopneumonia in children.Computer retrieval was performed on CNKI,Wanfang,VIP,SinoMed,PubMed,EMbase,Web of Science,and Cochrane Library databases for randomized controlled trial(RCT)on the treatment of bron-chopneumonia in children with TCM injections.The search time limit was from the establishment of each database to 2 January 2024.The relevant information of qualified literature was extracted,and data analysis was performed by using R 4.2.3 and Stata 15 soft-wares.The quality of the included studies was evaluated by the Cochrane risk of bias evaluation tool.Seventy RCTs were finally inclu-ded,with a total sample size of 8 629 cases,including 4 296 cases in experimental group and 4 333 cases in control group.The RCTs involved four TCM injections,namely Tanreqing Injection,Reduning Injection,Xiyanping Injection,and Yanhuning Injection.Net-work Meta-analysis showed that:① in terms of improving clinical total effective rate,surface under the cumulative ranking curve(SU-CRA)ranking was Xiyanping Injection+conventional treatment＞Tanreqing Injection+conventional treatment＞Reduning Injection+conventional treatment＞Yanhuning Injection+conventional treatment＞conventional treatment.②In terms of shortening recovery time of body temperature,SUCRA ranking was Yanhuning Injection+conventional treatment＞Xiyanping Injection+conventional treatment＞Reduning Injection+conventional treatment＞Tanreqing Injection+conventional treatment＞conventional treatment.③In terms of shortening cough disappearance time,SUCRA ranking was Yanhuning Injection+conventional treatment＞Xiyanping Injection+con-ventional treatment＞Reduning Injection+conventional treatment＞Tanreqing Injection+conventional treatment＞conventional treat-ment.④In terms of shortening lung rale disappearance time,SUCRA ranking was Xiyanping Injection+conventional treatment＞Re-duning Injection+conventional treatment＞Yanhuning Injection+conventional treatment＞Tanreqing Injection+conventional treat-ment＞conventional treatment.⑤In terms of shortening wheezing relief time,SUCRA ranking was Xiyanping Injection+conventional treatment＞Tanreqing Injection+conventional treatment＞Yanhuning Injection+conventional treatment＞Reduning Injection+con-ventional treatment＞conventional treatment.⑥In terms of shortening lung shadow disappearance time,SUCRA ranking was Reduning Injection+conventional treatment＞Yanhuning Injection+conventional treatment＞Tanreqing Injection+conventional treatment＞Xiyanping Injection+conventional treatment＞conventional treatment.⑦In terms of safety,42 RCTs reported the occurrence of ad-verse reactions,mainly in the form of gastrointestinal reactions and skin rashes.Current evidence shows that the four TCM injections in combination with conventional treatment are all effective in treating bronchopneumonia in children to varying degrees.Xiyanping Injec-tion+conventional treatment may be the most effective in improving clinical total effective rate,shortening lung rale disappearance time and wheezing relief time.Yanhuning Injection+conventional treatment may be the most effective in shortening recovery time of body temperature and cough disappearance time.Reduning Injection+conventional treatment may be the most effective in shortening lung shadow disappearance time.There were no serious adverse drug reactions during the treatment in both the experimental and control groups.Due to the limitations of the quality and quantity of the included literature,the above conclusions need to be further validated by more rigorously designed and high-quality RCT.
bronchopneumonia in childrentraditional Chinese medicine injectionnetwork Meta-analysis
NETL
NSTL
万方数据
