Clinical Efficacy Of Traditional Chinese And Western Medicine In Treatment Of Children With Influenza And COVID-19:Based On Systematic Review And Retrospective Clinical Case Analysis

Objective1.Based on literature search,systematic review were conducted to evaluate the clinical efficacy of integrated traditional Chinese and Western medicine in the treatment of influenza and Coronavirus Disease 2019(COVID-19)in children.2.Through retrospective clinical case analysis,to explore the clinical efficacy of integrated traditional Chinese and Western medicine in the treatment of children with COVID-19.In summary,clinical evidence is provided for the treatment of influenza and COVID-19 in children with integrated traditional Chinese and Western medicine.Methods1.The following databases were searched for study:CNKI,Wanfang,SinoMed,PubMed,Cochrane Library,and Embase.The published time of influenza literature is from their inception to December 2021.The published time of the COVID-19 literature is from the establishment of the database to February 2022.Two researchers independently extracted the data,assessed the methodological quality of the studies,and conducted a meta-analysis of the results using Review Manager 5.4.The efficacy and safety were assessed using forest plots,the methodological quality of the study was assessed using risk of bias table and publication bias was evaluated using a funnel plot.Systematic review or meta-analysis was performed according to the availability of literature data.The systematic review presents the results in a three-line table.2.Retrospectively collected clinical medical records of children with COVID-19 from 23 medical institutions in 10 provinces of Shaanxi,Sichuan,Hebei,Shanxi,Guangxi,Heilongjiang,Fujian,Chongqing,Anhui,and Zhejiang from December 2019 to December 2021.Retrieval is carried out through the Hospital Information System,and further extraction and analysis are carried out according to the principles of data standardization and inclusion and exclusion standards.Two researchers independently extracted and analyzed the data.Categorical variables were expressed as counts and percentages.Continuous variables were described using median with interquartile range.All statistical analyses were performed using SAS version 9.4.Results1.Study analysis of the treatment of influenza in children with integrated traditional Chinese and Western medicine results:A total of 21 randomized controlled trials(RCTs)involving 2960 cases were included.Compared to oseltamivir alone,combined treatment reduced the duration of symptoms,including that of fever(mean difference[MD]=-0.64,95%confidence interval[CI]:-0.86 to-0.41,P<0.00001),cough(MD=-0.82,95%CI:-1.02 to-0.62,P<0.00001),nasal obstruction(MD=-0.88,95%CI:-1.15 to-0.61,P<0.00001),and sore throat(MD=-0.92,95%CI:-1.26 to-0.57,P<0.00001).Combined therapy also reduced the time of viral shedding(MD=-0.53,95%CI:-0.70 to-0.36,P<0.00001)and the occurrence of adverse drug reactions(ADRs)[Risk Ratio(RR)=0.53,95%CI:0.34 to 0.83,P=0.005].Analysis of literature on the treatment of children with COVID-19 by integrated traditional Chinese and Western medicine results:A total of 20 studies were included,including 19 retrospective clinical observations and 1 RCT.Traditional Chinese medicine(TCM)treatment is mainly based on pattern classification of TCM decoction,supplemented by Chinese patent medicines(CPMs),TCM injection,and external treatment.The most common patterns are cold-dampness pattern and dampness-heat pattern.For cold-dampness pattern,the Qingfei Paidu Decoction is mostly used.For dampness-heat pattern,the Huoxiang Zhengqi Powder is mostly used.In the later stage,the pattern were mostly identified as lung and spleen Yin deficiency pattern,and Yupingfeng San,Shashen Maidong Decoction,and Shengmai San were often used.The most commonly used CPM is Lianhua Qingwen Capsule.Auxiliary injections include Xiyanping injection,Xuebijing injection,and Tanreqing injection.The external treatment method is mainly massage.Western medicine treatment mainly includes antiviral,antibacterial,and immunomodulatory drugs.At the same time,symptomatic and supportive treatments such as oxygen inhalation,nebulization,fluid replacement,and adjustment of intestinal flora were performed as needed.10 studies counted length of hospital stay.The length of hospital stay ranged from 9.5 to 32 days.9 studies counted the time of viral shedding.The viral shedding time range of the children was 1-32.6 days.One study counted the time to fever resolution was 1.76 days.One study counted the median time of stool viral shedding was 15.5 days.A RCT study included 100 children with dampness-heat obstructing the lung pattern.The treatment group used the massage with western medicine,and the control group used western medicine alone.The results showed that the pattern score of the treatment group was lower than that of the control group(P<0.05),the mean time of hospital stay of the two groups were(3.76±2.21)days and(4.66±2.18)days,respectively.There were no ADRs in both groups.Studies have shown that the addition of pediatric massage can shorten the course of the disease and relieve symptoms.2.Retrospective clinical case analysis of children with COVID-19 results:A total of 66 cases were included.Of which,43 cases were males(65.2%).The median age was 12 years[interquartile range(IQR)6-16].The asymptomatic,mild and moderate cases were 22(33.3%),respectively.39 cases(59.1%)have no symptom.Among those with clinical symptoms,the most common symptom was cough(19 cases,28.8%),followed by fever(11 cases,16.7%).46 cases(69.7%)were treated with integrated traditional Chinese and Western medicine,the median duration of hospital stay and viral shedding were 14(10.25-17.75)and 12(8-16)days,respectively.The most commonly used traditional Chinese medicine are Qingfei Paidu decoction and Lianhua Qingwen capsule.The most commonly used antiviral drug is interferon.All cases were cured and discharged.ConclusionsIn terms of children influenza treatment,the evidence-based of the efficacy and safety of integrated traditional Chinese and western medicine is relativity sufficient,which is conducive to guiding clinical treatment.In the aspect of treating COVID-19 in children,systematic review analysis and retrospective case analysis found that all children were cured and discharged,and no adverse reactions occurred during hospitalization.It initially showed that the combined traditional Chinese and Western medicine program was safe and effective,and had reference significance for the treatment of COVID-19 in children.The above results can provide a basis for doctors to guide medication and a reference for formulating TCM policies for the prevention and treatment of children influenza and COVID-19.