[关键词]
[摘要]
目的 系统评价5种清热解毒类中成药(抗感颗粒、板蓝根颗粒、连花清瘟颗粒、小儿牛黄清心散或小儿豉翘清热颗粒)联合奥司他韦治疗小儿流感的有效性和安全性,为临床治疗的选择提供依据。方法 检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台(Wanfang Data)、维普期刊中文数据库(VIP)、PubMed和Cochrane Library等中英文数据库,检索时间为建库至2021年1月。筛选清热解毒中成药联合奥司他韦(联合用药)对比奥司他韦单药治疗小儿流感的随机对照试验(RCT),采用RevMan 5.3软件进行Meta分析。结果 共纳入文献24篇RCTs,包含患儿2 932名,联合用药较奥司他韦单药治疗小儿流感可以减少发热缓解时间[MD=-20.37,95% CI=(-26.32,-14.43),P<0.05]和咳嗽缓解时间[MD=-20.45,95% CI=(-29.80,-11.10),P<0.05],增加C反应蛋白(CRP)下降值[MD=5.72,95% CI=(2.58,8.86),P<0.05],提高总有效率[RR=1.17,95% CI=(1.14,1.20),P<0.05],同时可以减少恶心呕吐[OR=0.44,95% CI=(0.24,0.80),P<0.05]和腹痛[OR=0.32,95% CI=(0.12,0.85),P=0.02]。结论 奥司他韦联合清热解毒类中成药治疗小儿流感可以减少发热缓解时间和咳嗽缓解时间,增加CRP下降值,提高总有效率,同时减少恶心呕吐和腹痛不良反应。但研究纳入例数有限、文献质量较低,需要设计严谨的多中心临床RCT增加论证强度。
[Key word]
[Abstract]
Objective To systematically evaluate the efficacy and safety of five kinds of Qingrejiedu Chinese medicine (Kanggan Granules, Ban-Lan-Gen Granules, Lianhua Qingwen Granules, Xiaoer Niuhuang Qingxin Powder and Xiaoer Chiqiao Qingre Granules) combined with oseltamivir versus oseltamivir on treatment of influenza in children, and to provide reference for clinical treatment. Methods Computer searches of CNKI, CBM, WanFang, VIP, PubMed and Cochrane Library were conducted to collect randomized controlled trials (RCTS) on one of five kinds of Qingrejiedu Chinese medicine combined with oseltamivir versus oseltamivir on treatment of pediatric influenza. The time limit for retrieval is from the establishment of the database to January 2021. Meta-analysis was conducted by using RevMan 5.3 statistical software. Results A total of 24 RCTs were included,involving 2 932 children with flu. Results of meta-analysis showed that oseltamivir combined with qingrejiedu Chinese medicine can reduce the duration of fever [MD = -20.37, 95%CI = (-26.32, -14.43), P < 0.05] and cough [MD = -20.45, 95%CI = (-29.80, -11.10), P < 0.05], increase in CRP decline [MD = 5.72, 95%CI = (2.58, 8.86), P < 0.05], versus oseltamivir on treatment of pediatric influenza. What's more, it can increase effective rate [RR = 1.17, 95%CI = (1.14, 1.20), P < 0.05] while reducing the adverse reactions of nausea [OR = 0.44, 95%CI = (0.24, 0.80), P < 0.05] and stomachache [OR = 0.32, 95%CI = (0.12, 0.85), P = 0.02]. Conclusion Oseltamivir combined with qingrejiedu Chinese medicine on treatment of influenza in children can reduce the duration of fever and cough, increase in CRP decline and effective rate while reduce the adverse reactions of nausea and stomachache. But cases of study were limited and the quality of the literature is low, and more rigorously designed multi-center clinical randomized controlled trials are necessary to strengthen the argumentation.
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[基金项目]
河北省2020年度医学科学研究课题计划资助项目(20200978)