以激素为对照的口服中药治疗肺间质纤维化的系统评价

目的：评价口服中药治疗肺间质纤维化的疗效和安全性。方法：计算机检索CNKI、VIP、CBM、PubMed和万方数据库等资源，收集以激素为对照的口服中药治疗肺间质纤维化的临床随机对照试验，按 Cochrane 系统评价方法，对纳入研究进行方法学质量评价，并采用 RevMan 5.2 软件进行 Meta 分析。结果：符合纳入标准的研究共22项（1 338例）。Meta分析结果显示：与激素比较，口服中药可提高治疗肺间质纤维化的有效率[RR=1.29，95%CI（1.16，1.42），P<0.000 01]；缓解咳嗽[MD=-0.57，95%CI（-0.83，-0.30），P<0.000 1]、喘息[MD=-0.67，95%CI（-1.20，-0.14），P=0.01]、气短[MD=-0.45，95%CI（-0.65，-0.25），P<0.000 1]等症状；改善肺部Velcro啰音[MD=-0.49，95%CI（-0.73，-0.25），P<0.000 1]；提高用力肺活量（FVC）[SMD=0.37，95%CI（0.16，0.58），P=0.000 7]、第一秒用力呼气量百分率（FEV1%）[MD=6.63，95%CI（1.67，11.60），P=0.009]、动脉血氧分压（PaO2）[MD=4.87，95%CI（2.74，7.01），P<0.000 01]；减少肺部再感染次数[RR=0.75，95%CI（0.67，0.84），P<0.000 01]。结论：口服中药较激素治疗肺间质纤维化具有一定的优势，但由于本系统评价纳入研究的方法学质量偏低，影响了结论的可靠性，该结论尚需更高质量、多中心、大样本的临床随机双盲对照试验加以证实。

A Systematic Review on Pulmonary Fibrosis Treatment with Oral Administration of Chinese Materia Medica Compared with Glucocorticoids

This study was aimed to evaluate the efficacy and safety of pulmonary fibrosis (PF) treatment with oral administration of Chinese materia medica (CMM). Randomized controlled trials (RCTs) on PF treatment with oral administration of CMM compared with glucocorticoids were searched from databases such as CNKI, VIP, CBM, PubMed and Wanfang. Methodology quality evaluation was conducted on the included RCTs according to the criteria of the Cochrane Handbook for Systematic Reviews. RevMan 5.2 software was used in the meta-analysis. The results showed that there were 22 RCTs (1338 cases) fitted the inclusion criteria. The meta-analysis results showed that compared with glucocorticoids, the oral administration of CMM can improve the effective rate of PF treatment [RR = 1.29, 95%CI (1.16, 1.42), P < 0.000 01]; it can relieve symptoms such as cough [MD = -0.57, 95%CI (-0.83, -0.30), P < 0.000 1], pant [MD = -0.67, 95%CI (-1.20, -0.14), P = 0.01], shortness of breath [MD = -0.45, 95%CI (-0.65, -0.25), P < 0.000 1]. It can improve the Velcro rale [MD = -0.49, 95%CI (-0.73, -0.25), P < 0.000 1]. It elevated forced vital capacity (FVC) [SMD = 0.37, 95%CI (0.16, 0.58), P = 0.000 7], FEV1% [MD = 6.63, 95%CI (1.67, 11.60), P = 0.009] and PaO2 [MD = 4.87, 95%CI (2.74, 7.01), P < 0.000 01], reduced lung reinfection [RR = 0.75, 95%CI (0.67, 0.84), P < 0.000 01]. It was concluded that compared with glucocorticoids, oral administration of CMM had certain advantages in PF treatment. However, the evidences were not strong enough due to the general low methodological quality. Hence, the conclusion still required to be verified with more high-quality, multiple centers, large sample size RCTs.