背景:抗生素耐药性已成为全球关注的问题。喜炎平注射液(XYP),中药注射剂,在中国已广泛用于化脓性急性扁桃体炎(SAT)的治疗,表现出临床疗效。因此,有必要进一步评估这种治疗的潜在有效性和安全性.这项荟萃分析整合了多项独立研究的数据,以评估XYP作为SAT患者辅助治疗的整体治疗效果。方法:对随机对照试验(RCT)的搜索涵盖了从开始到2024年4月1日的数据库,包括Cochrane图书馆,PubMed,Embase,SinoMed,CNKI,万方,VIP,和CBM。数据提取,方法学质量评估,和荟萃分析由两名研究人员独立进行。ReviewManager5.4用于数据分析。采用了各种工具进行评估,包括森林地块以可视化结果,漏斗图检测出版偏差,试验序贯分析来估计样本量,和等级来评估证据质量。结果:对32例RCTs4265例进行综合分析。与常规治疗(CT;β-内酰胺/盐酸克林霉素注射液/利巴韦林)相比,XYP联合CTs显示症状持续时间显著缩短.这包括喉咙痛(MD=-21.08,95%CI:-24.86至-17.29,p<0.00001),扁桃体红肿消失(平均差[MD]=-20.28,95%置信区间[CI]:-30.05至-10.52,p<0.0001),扁桃体脓性分泌物(MD=-22.40,95%CI:-28.04至-16.75,p<0.00001),和温度正常化(MD=-19.48,95%CI:-22.49至-16.47,p<0.00001)。此外,与单纯接受XYP的患者相比,接受CTs联合XYP的患者的白细胞介素-6(MD=-7.64,95%CI:8.41~-6.87,p<0.00001)和白细胞介素-8(MD=-5.23,95%CI:-5.60~-4.86,p<0.00001)水平较低.此外,联合治疗显着提高了恢复率(相对风险[RR]=1.55,95%CI:1.37至1.77,p<0.00001),白细胞计数恢复率(RR=1.13,95%CI:1.04~1.23,p=0.004),扁桃体红肿消失率(RR=0.51,95%CI:1.14~1.38,p<0.00001),不良事件无显著增加(RR=0.47,95%CI:0.20~1.10,p=0.08)。结论:目前的系统评价和荟萃分析初步表明,与单独的CTs相比,XYP和CTs的组合对SAT患者产生更好的临床结果。具有良好的安全性。尽管如此,这些发现需要通过更严格的RCT进一步证实,鉴于纳入研究中观察到的显著异质性和发表偏倚.系统审查注册:https://www。crd.约克。AC.uk/PROSPERO/display_record。php?RecordID=296118,标识符CRD42022296118。
Background: Antibiotic resistance has emerged as a global concern. Xiyanping injection (XYP), a traditional Chinese medicine injection, has been extensively utilized for the treatment of suppurative acute tonsillitis (SAT) in China, exhibiting clinical efficacy. Consequently, there is a need for further evaluation of the potential effectiveness and safety of this treatment. This meta-analysis consolidated data from multiple independent studies to assess the overall treatment efficacy of XYP as adjuvant therapy in patients with SAT. Methods: The search for randomized controlled trials (RCTs) encompassed databases from their inception to 1 April 2024, including the Cochrane Library, PubMed, Embase, SinoMed, CNKI, Wanfang, VIP, and CBM. Data extraction, methodological quality assessment, and meta-analysis were performed independently by two researchers. Review Manager 5.4 was used for data analysis. Various tools were employed for assessment, including forest plots to visualize results, funnel plots to detect publication bias, trial sequential analysis to estimate sample size, and GRADE to evaluate evidence quality. Results: A comprehensive analysis of 32 RCTs involving 4,265 cases was conducted. When compared to conventional treatments (CTs; β-lactams/clindamycin hydrochloride injection/ribavirin) alone, the combination of XYP with CTs demonstrated significant reductions in symptom duration. This included sore throat (MD = -21.08, 95% CI: -24.86 to -17.29, p < 0.00001), disappearance of tonsillar redness and swelling (mean difference [MD] = -20.28, 95% confidence interval [CI]: -30.05 to -10.52, p < 0.0001), tonsil purulent discharge (MD = -22.40, 95% CI: -28.04 to -16.75, p < 0.00001), and normalization of temperature (MD = -19.48, 95% CI: -22.49 to -16.47, p < 0.00001). Furthermore, patients receiving CTs combined with XYP exhibited lower levels of interleukin-6 (MD = -7.64, 95% CI: 8.41 to -6.87, p < 0.00001) and interleukin-8 (MD = -5.23, 95% CI: -5.60 to -4.86, p < 0.00001) than those receiving CTs alone. Additionally, the combination therapy significantly improved the recovery rate (relative risk [RR] = 1.55, 95% CI: 1.37 to 1.77, p < 0.00001), white blood cell count recovery rate (RR = 1.13, 95% CI: 1.04 to 1.23, p = 0.004), and disappearance rate of tonsillar redness and swelling (RR = 0.51, 95% CI: 1.14 to 1.38, p < 0.00001), with no significant increase in adverse events (RR = 0.47, 95% CI: 0.20 to 1.10, p = 0.08). Conclusion: The current systematic review and meta-analysis tentatively suggest that the combination of XYP and CTs yields superior clinical outcomes for patients with SAT compared to CTs alone, with a favorable safety profile. Nonetheless, these findings warrant further confirmation through more rigorous RCTs, given the notable heterogeneity and publication bias observed in the included studies. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296118, identifier CRD42022296118.