目的：中药（CHM）是最受欢迎的补充和替代疗法之一，已广泛用于治疗难治性肺炎支原体肺炎(RMPP)。然而,CHM的疗效和安全性仍存在争议。因此，我们进行了这项荟萃分析,以评估CHM联合治疗是否可以为患有RMPP的儿童和青少年带来益处.方法：截至2020年11月11日，按照PRISMA检查表，使用七个数据库进行数据检索。采用ReviewManager5.3、试验序贯分析0.9.5.10Beta软件和Stata16.0进行数据分析。采用平均差或风险比表示结果，其中应用95%置信区间(CI)。结果：一般来说，这项研究纳入了17项试验,1,451名参与者.总体汇总结果表明，CHM通过提高临床有效率对患有RMPP的儿童和青少年有益[RR=1.20，95％CI（1.15，1.25），p<0.00001],缩短退热时间[MD=-2.60，95%CI（-3.06，-2.13），p<0.00001],咳嗽消失时间[MD=-2.77，95%CI（-3.12，-2.42），p<0.00001],肺啰音消失时间[MD=-2.65，95%CI（-3.15，-2.15），p<0.00001],肺X线浸润消失时间[MD=-2.75,95%CI(-3.33,-2.17),p<0.00001],降低TNF-α水平[MD=-5.49，95%CI(-7.21，-3.77)，p<0.00001]。此外，亚组结果表明，祛痰和毒性疗法在缩短解热时间方面更具优势，咳嗽消失时间,肺X线浸润消失时间及降低TNF-α水平。同时，促进血液循环疗法似乎对缓解肺部啰音更好。然而,关于不良事件，两组无统计学差异[RR=0.97,95%CI(0.60,1.57),p=0.91]。结论：尽管在缓解临床症状方面取得了明显的积极效果，体征和减少炎症，由于质量和纳入研究的数量有限,确认CHM治疗RMPP的疗效还为时过早.更大规模，双盲,精心设计,未来的研究需要随机对照试验。
Objectives: Chinese herb medicine (CHM) is one of the most popular complementary and alternative therapies, which has been widely used to treat Refractory Mycoplasma Pneumoniae Pneumonia (RMPP). However, the effect and safety of CHM remain controversial. Hence, we conducted this meta-analysis to evaluate whether CHM combination therapy could bring benefits to children and adolescents with RMPP. Methods: Seven databases were used for data searching through November 11, 2020 following the PRISMA checklist generally.
Review Manager 5.3, Trial sequential analysis 0.9.5.10 Beta software and Stata16.0 were applied to perform data analyses. Mean difference or risk ratio was adopted to express the results, where a 95% confidence interval (CI) was applied. Results: In general, this research enrolled 17 trials with 1,451 participants. The overall pooled results indicated that CHM was beneficial for children and adolescents with RMPP by improving the clinical efficacy rate [RR = 1.20, 95% CI (1.15, 1.25), p < 0.00001], shortening antipyretic time [MD = -2.60, 95% CI (-3.06, -2.13), p < 0.00001], cough disappearance time [MD = -2.77, 95% CI (-3.12, -2.42), p < 0.00001], lung rale disappearance time [MD = -2.65, 95% CI (-3.15, -2.15), p < 0.00001], lung X-ray infiltrates disappearance time [MD = -2.75, 95% CI (-3.33, -2.17), p < 0.00001], reducing TNF-α level [MD = -5.49, 95% CI (-7.21, -3.77), p < 0.00001]. Moreover, subgroup results suggested that removing heat-phlegm and toxicity therapy had more advantages in shortening antipyretic time, cough disappearance time, lung X-ray infiltrates disappearance time and reducing TNF-α level. Meanwhile promoting blood circulation therapy seemed to be better at relieving lung rale. However, regarding adverse events, the two groups displayed no statistical difference [RR = 0.97, 95% CI (0.60, 1.57), p = 0.91]. Conclusion: Despite of the apparently positive results in relieving clinical symptoms, physical signs and reducing inflammation, it is premature to confirm the efficacy of CHM in treating RMPP because of the limitation of quality and the number of the included studies. More large-scale, double-blind, well-designed, randomized controlled trials are needed in future research.
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