Systematic Review And Meta-analysis Of Tanreqing Injection In The Treatment Of Children With Mycoplasma Pneumoniae Pneumonia

Objective:To systematically evaluate the efficacy and safety of Tanreqing injection combined with western medicine in the treatment of mycoplasma pneumoniae pneumonia in children,and to provide evidence-based support for clinical medication.Methods:The evaluation technical route was established according to the PRISMA statement,and the Chinese and foreign language databases(CBMdisc,CNKI,VIP,Wan Fang,The Cochrane Library,Pubmed,Embase,Web of Science)were searched by computer.The literature retrieval time was from the establishment of each database to January 2021.The randomized controlled trials of Tanreqing injection combined with western medicine in the treatment of mycoplasma pneumoniae pneumonia in children were collected,and the inclusion and exclusion criteria were established according to the PICOS principle of Cochrane Handbook.The data were extracted after de-duplication and manual screening,and the literature quality was evaluated by using"Improved Jadad Scale"and"Cochrane Bias Risk Assessment Tool".Rev Man5.3.5 and Stata SE15.1 were used for Meta analysis,including combined effect,heterogeneity test,publication bias"funnel chart"test by Rev Man5.3.5,sensitivity analysis,Meta regression,Egger's test and Begg's test by Stata SE15.1.Results:A total of 44 RCT studies were included,including 4249 children,2127in the trial group and 2122 in the control group.Meta analysis showed that the"Total effective rate"RR=1.21,95%CI[1.18,1.24],Z=13.91(P<0.00001).In terms of the improvement of clinical symptoms,WMD=-1.47,95%CI[-1.82,1.12],Z=8.26(P<0.00001),"Cough disappearance time"WMD=-1.97,95%CI[-2.30,1.64],Z=11.72(P<0.00001)."Lung rale disappearance time"WMD=-1.99,95%CI[-2.37,1.62],Z=10.45(P<0.00001);"Chest X-ray absorption time"WMD=-1.87,95%CI[-1.98,1.76],Z=33.22(P<0.00001).In terms of serum inflammatory factor indexes,"IL-6"SMD=-1.46,95%CI[-1.96,0.96],Z=5.70(P<0.00001);"IL-8"SMD=-1.81,95%CI[-2.33,1.29],Z=6.77(P<0.00001)."IL-10"SMD=-2.08,95%CI[-3.01,1.16],Z=4.43(P<0.00001);"IL-18"SMD=-15.75,95%CI[-18.12,13.39],Z=13.06(P<0.00001);"CRP"SMD=-2.66,95%CI[-3.09,2.22],Z=12.00(P<0.00001)."PCT"SMD=-0.58,95%CI[-1.15,0.00],Z=1.97(P<0.00001);"TNF-?"SMD=-2.31,95%CI[-3.02,1.59],Z=6.31(P<0.05).In terms of immune function,"CD3⁺(%)"WMD=5.99,95%CI[1.79,10.18],Z=2.80(P=0.005);"CD4⁺(%)"WMD=5.47,95%CI[4.48,6.47],Z=10.79(P<0.00001);"CD4⁺/CD8⁺"WMD=0.42,95%CI[0.22,0.63],Z=4.03(P<0.00001)."CD8⁺(%)"WMD=-3.21,95%CI[-4.19,2.23],Z=6.41(P<0.00001)."Ig A"WMD=0.24,95%CI[0.11,0.38],Z=3.50(P=0.0005);"Ig M"WMD=0.27,95%CI[0.20,0.35],Z=7.07(P<0.00001);"Ig G"WMD=1.11,95%CI[0.91,1.31],Z=10.77(P<0.00001).In terms of pulmonary function indexes,"FEV₁/FVC"WMD=5.84,95%CI[3.65,8.02],Z=5.23(P<0.00001);"PEF"WMD=7.98,95%CI[6.12,9.83],Z=8.43(P<0.00001);"FEV₁"WMD=7.14,95%CI[5.54,8.75],Z=8.72(P<0.00001).In terms of myocardial zymogram,"CK"WMD=-3.63,95%CI[-4.37,2.89],Z=9.57(P<0.00001);"LDH"WMD=-28.45,95%CI[-31.11,25.78],Z=20.93(P<0.00001);"CK-MB"WMD=-7.90,95%CI[-8.87,6.93],Z=16.00(P<0.00001)."AST"WMD=-10.61,95%CI[-11.85,9.37],Z=16.80(P<0.00001).In terms of safety:"Incidence of adverse reactions"RR=0.41,95%CI[0.34,0.49],Z=9.40(P<0.00001)."Diarrhea"RR=0.42,95%CI[0.26,0.70],Z=3.38(P=0.0007);"Nausea and vomiting"RR=0.51,95%CI[0.37,0.71],Z=3.98(P<0.0001);"Abdominal pain"RR=0.50,95%CI[0.32,0.78],Z=3.09(P=0.002);"Local venous pain"RR=0.74,95%CI[0.16,3.40],Z=0.38(P=0.70);"Rash"RR=0.26,95%CI[0.01,2.67],Z=1.90(P=0.06);"Abnormal liver function"RR=0.40,95%CI[0.08,3.20],Z=1.11(P=0.27)?The heterogeneity sources of the outcome indexes with high degree of variation were explored by subgroup analysis and Meta regression analysis,but could not be fully explained.After sensitivity analysis,there was no qualitative change in the outcome indexes.Funnel chart and statistical test showed that some outcome indexes had publication bias.Conclusion:In the treatment of Mycoplasma pneumoniae pneumonia in children,Tanreqing injection combined with macrolide antibiotics and other conventional western medicine can significantly improve the total effective rate and reduce the incidence of adverse reactions compared with only conventional western medicine.It has more advantages in shortening the time of clinical symptoms,reducing the level of serum inflammatory factors and myocardial enzymes,improving immunity and improving children's lung function.However,given that the number of clinical randomized controlled trials currently included is still small,the overall literature quality is low,and there are publication bias in the analysis results of some outcome indicators,more fully designed and rigorous clinical randomized controlled trials are still needed in the future to provide data for evidence-based research,so as to obtain higher quality evidence support.