| ObjectiveRespiratory diseases are common diseases that seriously endanger people's health in recent years.WHO reports that the mortality of respiratory diseases ranks third in the global non-communicable disease,next only to cardiovascular diseases and neoplasm,which has caused a great burden on the health and economy of people all over the world.Chinese herbal injection(CHI)has been widely used in the treatment of respiratory diseases,and its efficacy has been proved by many scholars through the method of meta-analysis.There are many kinds of CHIs in the treatment of respiratory diseases,but there is a lack of direct comparative clinical studies of different CHIs to prove which CHI has the best efficacy,which makes it difficult for clinical medical staff to select better and more suitable therapeutic measures quickly.In view of this,it is of great clinical value and academic significance to explore a new method to evaluate the efficacy of different CHIs in the treatment of respiratory diseases.The network meta-analysis(NMA)can obtain the ranking of various interventions'efficacy by comprehensive analysis of direct and indirect evidence.Based on this,this study intended to use NMA to evaluate the clinical efficacy of different CHIs in the treatment of respiratory diseases,so as to provide high-quality evidence-based medical evidence for clinical decision.The respiratory diseases involved in this study included acute exacerbation of chronic obstructive pulmonary disease(AECOPD),mycoplasma pneumonia in children(MPC),bronchopneumonia in children(BC)and herpangina.MethodsInclusion criteria were formulated according to internationally recognized PICOS principle.Randomized controlled trials(RCTs)were collected from databases at home and abroad.Included studies were screened according to the established inclusion criteria.The quality of the included studies was evaluated.Based on Bayesian theory,WinBUGS software was used to analyze data.And WinBUGS results were invoked by Stata software to obtain the surface under the cumulative ranking probabilitie(SUCRA).The network diagram,comparison-adjusted funnel plot,inconsistency test diagram and cluster analysis diagram were drawn to identify the best intervention measures.Results1.The results of CHIs for acute exacerbation of chronic obstructive pulmonary disease155 RCTs were included,involving 12 kinds of CHIs(Chuanxiongqin injection(CXQ),Chuankezhi injection(CKZ),Danhong injection(DH),Huangqi injection(HQ),Reduning injection(RDN),Shenfu injection(SF),Shenmai injection(SM),Shengmai injection(SMI),Tanreqing injection(TRQ),Xiyanping injection(XYP),Xixinnao injection(XXN),Xuebijing injection(XBJ))and 9 different outcome indicators.The results of network meta-analysis showed that in terms of clinical total effective rate,all CHIs combined with western medicine(WM)had better effect than WM alone,and DH+WM had better effect than SF+WM.The FEVi%results indicated that SM+WM,RDN+WM and HQ+WM were more effective than WM alone.Likewise,SM+WM yielded a better result than XYP+WM.In terms of FEV1/FVC,TRQ+WM was the only therapy that was significantly better than WM.SMI+WM showed significant benefits in PaCO2 when compared with WM.In the case of PaO2,patients who received TRQ+WM had better PaO2 than those treated with WM alone.The result of SUCRA showed that among all outcomes,the efficacy of CHIs+WM was better than WM.In terms of clinical total effective rate,DH+WM was the most likely to be the best intervention.RDN+WM has the best efficacy in FEVi/FVC,pH,white blood cell count.SM+WM,XXN+WM,SMI+WM,TRQ+WM and CKZ+WM were the best interventions for FEV1%,PaO2,PaCO2,C-reactive protein and neutrophil percentage,respectively.Cluster analysis showed that HQ+WM was associated with a comprehensive improvement of clinical total effective rate and FEVi%,and clinical total effective rate and C-reactive protein.Similarly,XXN+WM,RDN+WM and HQ+WM were associated with a positive effect on clinical total effective rate and PaO2.2.The results of CHIs for mycoplasma pneumonia in children167 RCTs were included,involving 5 kinds of CHIs(RDN,TRQ,XYP,XXN,Yanhuning injection(YHN))and 8 different outcome indicators.The results of network meta-analysis showed that all CHIs combined with azithromycin(AZM)were superior to AZM in improving the clinical total effective rate.Compared with AZM,4 kinds of CHIs combined with AZM,in addition to XXN,could better reduce the patient's fever time,cough disappearance time,lung rale disappearance time,and hospitalization time.RDN+AZM,XYP+AZM and YHN+AZM could reduce the recovery time of X-ray signs compared with AZM alone.RDN+AZM could improve the levels of TNF-alpha and IL-6 in patients compared with AZM alone.YHN+WM,when compared with XYP+AZM,could better reduce the cough disappearance time and average hospitalization time,and when compared with the other CHIs combined with AZM,it could reduce the lung rale disappearance time.The result of SUCRA showed that among all outcomes,the efficacy of CHIs combined with AZM was better than AZM.TRQ+AZM was the most likely intervention to improve the clinical total effective rate.RDN+AZM had the best effect on reducing fever time and improving the levels of TNF-alpha and IL-6.YHN+AZM was the best intervention to reduce the disappearance time of cough,lung rale,average hospitalization time and X-ray signs.Cluster analysis showed that RDN+AZM had obvious effect in the comprehensive analysis of clinical total effective rate and antipyretic time,clinical total effective rate and hospitalization time,and clinical total effective rate and TNF-alpha.3.The results of CHIs for bronchopneumonia in children168 RCTs were included,involving 6 kinds of CHIs(Chuanhuning(CHN),RDN,TRQ,XYP,XXN,YHN)and 7 different outcome indicators.The results of network meta-analysis showed that among the different outcomes,the efficacy of most CHIs combined with WM was better than WM alone.The result of SUCRA showed that the efficacy of CHIs combined with WM was better than WM among all outcomes.In terms of clinical total effective rate,XXN+WM was the most likely to be the best intervention.In addition,it was also the best intervention in terms of reducing fever time,cough disappearance time and pulmonary shadow disappearance time.As for the disappearance time of lung shadow,asthma and hospitalization time,YHN+WM was the best intervention measure.Cluster analysis showed that XXN+WM was the best intervention when comprehensive analysis of clinical total effective rate and other outcomes.4.The results of CHIs for herpangina72 RCTs were included 5 involving 6 kinds of CHIs(RDN,Shuanghuanglian(SHL),TRQ,XYP,XXN,YHN)and 3 different outcome indicators.The results of network meta-analysis showed that RDN,XYP and YHN were better than ribavirin in all outcome indicators.And SHL and TRQ were better than ribavirin in clinical total effective rate.The result of SUCRA showed that RDN ranked first among all the outcomes,and the efficacy of all CHIs was better than ribavirin.Cluster analysis showed that RDN has the best efficacy in clinical total effective rate and antipyretic time,and clinical total effective rate and disappearance time of herpes.ConclusionsCHIs combined with WM was superior to WM in the treatment of respiratory diseases.In the treatment of AECOPD,the efficacy of DH+WM,RDN+WM and HQ+WM deserved our attention.As for MPC,TRQ+AZM,RDN+AZM and YHN+AZM had relatively prominent curative effect.In regard to BC,XXN+WM had a relatively better effect.In the treatment of herpangina,we should pay special attention to RDN.However,different kinds of CHIs have different effects on various outcomes.Clinicians should choose appropriate treatment methods according to patients' physical needs. |
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