中药治疗病毒后间质性肺纤维化的系统性评价和Meta分析

Traditional Chinese Medicine in the Treatment of Post-Viral Interstitial Pulmonary Fibrosis: A Systematic Review and Meta-Analysis

摘要: 目的：研究通过Meta分析的方法，对近年来运用中医药干预治疗病毒后间质性肺纤维化有效性以及安全性进行客观评价，以期为今后应用中医药治疗本病提供更多的循证依据。方法：计算机检索中英文数据库，时限均自建库起至2024年03月01日，经文献筛选、数据提取后，对纳入文献的结果及结论进行描述性分析，采用PRISMA声明对纳入研究的文献质量进行评价，应用AMSTAR 2量表对方法学质量进行评价，运用RevMan5.4进行Meta分析。结果：共纳入7篇文献，包含8个随机对照研究，包含临床治疗患者844例，其中试验组437例，对照组407例。与对照组相比，试验组(中药/中药联合西医常规治疗)临床症状改善[OR = 3.22, 95% CI (2.20, 4.72), P < 0.00001] [MD = −0.79, 95% CI (−0.19, −0.48), P < 0.00001]；肺部纤维化得到改善[MD = −2.74, 95% CI (−4.09, −1.38), P < 0.00001]。肺功能(DLCO)并没有改善，差异无统计学意义[MD = 3.29, 95% CI (−0.67, 7.25), P = 0.10]。1个研究报告了不良反应，主要症状为心悸、胃食管反流、口腔溃疡、腹泻，可自行缓解或消失。结论：当前证据显示，中药不论是汤剂还是中成药亦或是中药制剂，其治疗病毒后间质性肺纤维化，能够有效改善患者呼吸困难、喘息、憋气等临床症状，提高患者生活质量；延缓肺部纤维化的进展；暂未报告严重不良反应。但研究结论尚需更多标准严格、质量高、大样本的随机对照试验研究予以证实。

Abstract: Objective: To objectively evaluate the effectiveness and safety of the intervention of Traditional Chinese Medicine (TCM) in the treatment of post-viral interstitial pulmonary fibrosis using meta-analysis, with the aim of providing more evidence-based support for the future application of TCM in treating this condition. Method: A computerized search was conducted in both Chinese and English databases, with the time limit extending up to March 1, 2024. Following literature screening and data extraction, a descriptive analysis of the results and conclusions of the included studies was performed. The quality of the included studies was evaluated using the PRISMA statement, and the methodological quality was assessed using the AMSTAR 2 tool. Meta-analysis was conducted using RevMan 5.4. Results: A total of 7 studies were included, comprising 8 randomized controlled trials with 844 clinical treatment patients, of which 437 were in the experimental group and 407 in the control group. Compared to the control group, the experimental group (TCM/TCM combined with conventional Western medicine treatment) showed significant improvement in clinical symptoms [OR = 3.22, 95%CI (2.20, 4.72), P < 0.00001] [MD = −0.79, 95% CI (−0.19, −0.48), P < 0.00001]; pulmonary fibrosis was also improved [MD = −2.74, 95% CI (−4.09, −1.38), P < 0.00001]. However, there was no significant improvement in lung function (DLCO), with no statistically significant difference [MD = 3.29, 95% CI (−0.67, 7.25), P = 0.10]. One study reported adverse reactions, mainly symptoms such as palpitations, gastro esophageal reflux, oral ulcers, and diarrhea, which could resolve on their own or disappear. Conclusion: Current evidence indicates that TCM, whether in the form of decoctions, patented medicines, or herbal preparations, can effectively improve clinical symptoms such as dyspnea, wheezing, and breathlessness in patients with post-viral interstitial pulmonary fibrosis, thereby enhancing their quality of life and delaying the progression of pulmonary fibrosis. No severe adverse reactions have been reported thus far. However, the conclusions of the study still require confirmation through more rigorous, high-quality, large-sample randomized controlled trials.