Meta-analysis And GRADE Evidence Classification Of Maxingshigan Decoction Combined With Western Medicine In The Treatment Of Community-acquired Pneumonia

PurposeThrough meta-analysis,the combined outcome indicators were summarized,and the clinical efficacy and safety of Maxing Shigan Decoction combined with Western medicine in the treatment of community-acquired pneumonia were systematically evaluated,and the quality of relevant evidence was evaluated to provide a more stronger evidence-based basis for clinical treatment.MethodComputer search of Pub Med,EMbase,Cochrane Library,China Knowledge Network(CNKI),China Biomedical Literature Database(CBM),Wanfang Database and Chongqing VIP Database(VIP)and other domestic and foreign databases through the search strategy,the search terms are "pneumonia","Community acquired pneumonia","CAP","Maxing Shigan Decoction","Mahuang Xingren Gancao Shigao Decoction","pneumonia","Community acquired pneumonia" and other subject terms and corresponding free words.The search time limit was a clinical randomized controlled trial of Maxing Shigan Decoction combined with Western medicine in the treatment of community-acquired pneumonia published from June 2015 to June 2020.Rev Man5.3 and Stata MP16.0 software were used for data analysis,and the improved Jadad score table was used to evaluate the literature quality of the included literature,and the GRADE evaluation standard was used to evaluate the quality of evidence for each outcome indicator.ResultsFirst.In the end,17 articles that met the criteria were included,and the improved Jadad score was used to evaluate their quality.Among them,7 were high-quality documents and 10 were low-quality documents,which may cause bias in the results.Second.The meta-analysis of Maxing Shigan Decoction combined with Western medicine in the treatment of communityacquired pneumonia showed that the experimental group were better than the control group on the total effective rate[RR=1.15,95%CI(1.10,1.19),P<0.00001],and fever reduction time[SMD=-0.87,95%CI(-1.05,-0.70),P<0.00001],cough and sputum disappearance time [SMD=-0.86,95%CI(-1.05,-0.67),P<0.00001],Pulmonary rales disappearance time [SMD=-0.84,95%CI(-1.04,-0.64),P<0.00001],Imaging absorption time [SMD=-0.78,95%CI(-1.47,-0.09),P=0.03],The average length of hospital stay[SMD=-0.82,95%CI(-1.07,-0.58),P<0.00001],etc.the experimental group WBC count level after treatment[SMD=-0.60,95%CI(-0.76,-0.44),P<0.00001],NEU% after treatment[SMD=-0.33,95%CI(-0.65,-0.01),P=0.04],CRP level after treatment[SMD=-1.33,95%CI(-2.09,-0.58),P=0.0005],Pct level after treatment[SMD=-1.08,95%CI(-1.53,-0.63),P<0.00001],ESR level after treatment[SMD=-0.90,95%CI(-1.18,-0.61),P<0.00001]and other aspects are better than the control group.the above indicators were all statistically significant.There was no significant difference between the experimental group and the control group in the occurrence of adverse reactions,which was not statistically significant.Third.Fever reduction time,cough and sputum disappearance time,pulmonary rales disappearance time,and WBC level after treatment are moderate-quality evidence;total effective rate,NEU% after treatment are low-quality evidence;Imaging absorption time,average hospital stay,and CRP after treatment,Pct,ESR levels are very low-quality evidence.ConclusionsModified Maxingshigan Decoction combined with western medicine treatment can significantly improve the clinical efficacy of community-acquired pneumonia,significantly shorten the time of fever,reduce the time for coughing,sputum and pulmonary rales to disappear,accelerate the absorption of chest radiographs,and shorten the average length of hospital stay.It reduces the levels of inflammatory indicators such as WBC,NEU%,CRP,Pct,ESR,inhibits the infiltration of inflammatory factors,and does not increase the occurrence of adverse reactions.It is worthy of clinical application.However,the quality of the included literature in this study is generally low,and the level of evidence as a whole is lowquality evidence,which has certain limitations.In the future,it is necessary to design more large-sample,multi-center,high-quality studies to strengthen the strength of evidence and make it better.The service serves the clinic better.