儿童哮喘中医体质类型分布的系统评价与定性综述

Systematic Evaluation and Narrative Synthesis of TCM Constitution Type Distribution in Children with Asthma

摘要: 目的：总结儿童哮喘患者中医体质类型的报告分布，明确目前文献中较常见、较值得关注的主要体质类型，并评价现有证据的可靠性及其方法学局限。方法：检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(Wanfang Data)、重庆维普中文科技期刊数据库(VIP)、PubMed及Web of Science中与儿童哮喘中医体质类型相关的临床研究。鉴于纳入研究间异质性极高，且体质类型可能存在兼夹体质所致的非互斥计数问题，本研究不再将单组率合并结果作为主要证据，而采用定性叙述性综述，展示单项研究报告比例及Wilson 95%置信区间。结果：共纳入12项研究。定性汇总显示，特禀质、气虚质和痰湿质是儿童哮喘患儿文献中反复报告且证据量相对集中的三类主要偏颇体质。其中，气虚质见于12项研究，报告比例为9.4%~89.3%，中位数为26.7%；特禀质见于11项研究，报告比例为12.0%~96.0%，中位数为52.3%；痰湿质见于11项研究，报告比例为5.8%~54.7%，中位数为19.2%。阳虚质、阴虚质、湿热质、平和质、瘀血质及气郁质亦有报道，但证据量和比例稳定性相对不足。地区和年龄亚组结果受分母口径、研究来源和体质判定方式影响，难以进行稳定合并解释。结论：现有证据初步提示，特禀质、气虚质和痰湿质可能是儿童哮喘患儿中较主要、较常见的中医体质类型，提示临床体质辨识和后续研究可重点关注过敏易感、肺脾气虚及痰湿内蕴相关体质特征。但该发现仍属于探索性描述，受研究异质性、体质测量工具不统一、兼夹体质资料不足及报告标准不一致等因素限制，当前证据不足以支持稳定的合并比例估计或确定性因果判断。

Abstract: Objective: To summarize the reported distribution of traditional Chinese medicine (TCM) constitution types in children with asthma, identify the main constitution types most frequently reported in the current literature, and evaluate the reliability and methodological limitations of the available evidence. Methods: Clinical studies on TCM constitution types in children with asthma were retrieved from CBM, CNKI, Wanfang Data, VIP, PubMed and Web of Science. Because the included studies showed extremely high between-study heterogeneity and possible non-mutually exclusive counting caused by combined constitution types, pooled single-arm proportions were no longer interpreted as the primary evidence. A narrative synthesis was conducted, and individual study proportions with Wilson 95% confidence intervals were displayed. Results: Twelve studies were included. Special diathesis, qi-deficiency and phlegm-dampness constitutions were the three biased constitution types most repeatedly reported and most concentrated in the available evidence. Qi-deficiency constitution was reported in 12 studies, with reported proportions ranging from 9.4% to 89.3% and a median of 26.7%; special diathesis constitution was reported in 11 studies, ranging from 12.0% to 96.0%, with a median of 52.3%; phlegm-dampness constitution was reported in 11 studies, ranging from 5.8% to 54.7%, with a median of 19.2%. Constitutions such as Yang deficiency constitution, Yin deficiency constitution, dampness-heat constitution, balanced constitution, blood stasis constitution, and qi stagnation constitution have also been reported, but the volume of evidence and consistency of proportions remain relatively insufficient. Results across regional and age subgroups are influenced by differences in denominator scope, study sources, and constitution assessment methods, making stable combined interpretation challenging. Conclusion: Current evidence preliminarily suggests that special constitution, qi deficiency constitution, and phlegm-dampness constitution may represent the most prevalent TCM constitution types among children with asthma, indicating that clinical constitution identification and future research should prioritize characteristics related to allergic susceptibility, lung-spleen qi deficiency, and internal accumulation of phlegm-dampness. However, this finding remains exploratory; limitations including study heterogeneity, inconsistent measurement tools for constitution assessment, inadequate data on coexisting constitutions, and non-uniform reporting standards render current evidence insufficient for establishing consistent combined proportion estimates or definitive causal relationships.