Comparative effectiveness research of Chinese medicine and integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia: a retrospective cohort study design_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Xiaowen ¹ , HUANG Suihe ² , CAI Jianxiong ³ , HUANG Zhen ² , XIE Qianwen ³ , XIE Qingfeng ² , SUN Liangsheng ² , YANG Zhimin ³ ,  WU Darong ³ ,  YAN Fang ^2,4

1. The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;
2. Classical Traditional Chinese Medicine Ward, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510145, P. R. China;
3. State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, P. R. China;
4. Li Ke and Qi Yu-ru Academic Experience Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510145, P. R. China;

Corresponding?author：

WU Darong, Email: darongwu@gzucm.edu.cn; YAN Fang, Email: yanf@gzucm.edu.cn

Keywords：

Pneumonia; Chinese medicine; Integrated Chinese and Western medicine; Retrospective cohort study

DOI：

10.7507/1672-2531.202405051

Video：

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Objective To compare the clinical effectiveness of Chinese medicine with that of integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia. Methods The electronic medical record (EMR) of patients with pneumonia who were admitted to the Classical Department of Chinese Medicine of Guangdong Hospital of Traditional Chinese Medicine from November 29, 2012 to June 17, 2022 were retrospectively collected. The patients were divided into two groups according to whether they were treated with antimicrobial drugs on the basis of Chinese medicine treatment. The non-exposed group was the traditional Chinese medicine group, and the exposed group was the integrated Chinese medicine and antimicrobial drugs group. Propensity score matching method was used to balance possible confounding factors. COX regression analysis was performed on the matched cohort to compare death rates among the groups, and Kaplan-Meier curve was drawn to evaluate the survival probability during hospitalization. The proportion of maximum oxygen concentration and duration of fever remission were compared between the two groups. Results This study included a total of 898 cases, with the majority (over 95%) falling within the range of mild to moderate severity. After propensity score matching,180 patients remained in each group, among whom the baseline characteristics were comparable. The primary outcome indicators showed that the risk of death during hospitalization was same in the integrated Chinese medicine and antimicrobial drugs group and in the Chinese medicine group (HR=1.52, 95%CI 0.36 to 6.39, P=0.566), the subgroup analysis was consistent with the overall trend of the results, and the differences were not statistically significant. The results indicate that during the hospitalization, the overall and subgroup mortality rates were similar between the two groups. The treatment effectiveness on the disappearance of major symptoms such as fever, cough, sputum production, fatigue, shortness of breath, and chest pain were comparable in both groups. The secondary outcome indicators showed that there was no statistical significance in the comparison of the proportion of maximum oxygen therapy concentration and the stable duration of fever remission between the two groups. Conclusion In the treatment of patients with mainly mild to moderate pneumonia, the effectiveness of the Chinese medicine group and the integrated Chinese medicine and antimicrobial drugs group in the hospitalization mortality, the disappearance of major symptoms, the proportion of maximum oxygen therapy concentration and the stable duration of fever remission are similar. Chinese medicine has a positive significance in reducing the use of antimicrobials in patients with pneumonia.

Citation： ZHOU Xiaowen, HUANG Suihe, CAI Jianxiong, HUANG Zhen, XIE Qianwen, XIE Qingfeng, SUN Liangsheng, YANG Zhimin, WU Darong, YAN Fang. Comparative effectiveness research of Chinese medicine and integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia: a retrospective cohort study design. Chinese Journal of Evidence-Based Medicine, 2024, 24(12): 1376-1383. doi: 10.7507/1672-2531.202405051 Copy

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2.	國家衛生健康委員會統計信息中心. 2022中國衛生健康統計年鑒. 2023.
3.	Di Pasquale MF, Sotgiu G, Gramegna A, et al. Prevalence and etiology of community-acquired pneumonia in immunocompromised patients. Clin Infect Dis, 2019, 68(9): 1482-1493.
4.	Aliberti S, Reyes LF, Faverio P, et al. Global initiative for meticillin-resistant staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis, 2016, 16(12): 1364-1376.
5.	熊旭東, 錢義明, 陸一鳴, 等. 中西醫聯合治療社區獲得性肺炎專家共識(2014版). 中國中西醫結合急救雜志, 2015, (1): 1-6.
6.	彭明松. 中醫辨證治療老年肺炎的療效觀察. 臨床醫藥文獻電子雜志, 2019, 6(8): 80.
7.	余學慶, 謝洋, 李建生. 社區獲得性肺炎中醫診療指南(2018修訂版). 中醫雜志, 2019, 60(4): 350-360.
8.	王曉錦, 李爭, 李風森. 中藥湯劑治療成人重癥肺炎療效的網狀Meta分析. 海南醫學院學報, 2023, 30(13): 1002-1018.
9.	中華中醫藥學會肺系病分會. 中醫藥單用/聯合抗生素治療社區獲得性肺炎臨床實踐指南. 中日友好醫院學報, 2021, 35(1): 8-11, 15.
10.	Xie K, Guan S, Jing H, et al. Efficacy and safety of traditional Chinese medicine adjuvant therapy for severe pneumonia: evidence mapping of the randomized controlled trials, systematic reviews, and meta-analyses. Front Pharmacol, 2023, 14: 1227436.
11.	國鈺妍. 中醫辨證論治與奧司他韋治療流感輕癥的臨床隨機對照研究. 北京: 北京中醫藥大學, 2014.
12.	顏芳, 楊志敏, 徐國峰, 等. 運用經方純中醫治療肺部感染102例. 北京: 國際(中日韓)經方學術會議第二屆全國經方論壇暨經方應用高級研修班, 2011.
13.	Su G, Xu Y, Xu X, et al. Association between reduced renal function and cardiovascular mortality in patients hospitalized with infection: a multi-center cohort study. Eur J Intern Med, 2018, 57: 32-38.
14.	中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
15.	Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003, 58(5): 377-382.
16.	張涌彬, 李若愚, 賴海峰. 瀉肺通腑法治療老年重癥肺炎合并胃腸功能障礙的臨床療效. 內蒙古中醫藥, 2019, 38(10): 129-131.
17.	章昕, 蔡玲, 王秋雁. 痰熱清注射液對呼吸機相關性肺炎患者感染參數和臨床預后的影響. 中國中醫急癥, 2012, 21(8): 1223, 1241.
18.	王知兵, 于克靜, 劉倩倩, 等. 加味宣白承氣湯輔助治療重癥創傷呼吸機相關性肺炎痰熱壅肺證患者30例臨床觀察. 中醫雜志, 2023, 64(3): 269-274.
19.	李得民, 齊蕊涵, 張洪春, 等. 《中醫藥單用/聯合抗生素治療社區獲得性肺炎臨床實踐指南》臨床應用評價與修訂意見. 中國中藥雜志, 2018, 43(24): 4759-4764.
20.	黃維俊. 過用抗生素與中醫寒郁現象. 河北中醫, 2005, (3): 190.
21.	周育平. 李春生教授治療抗生素相關性腹瀉經驗. 中國中醫急癥, 2003, (1): 49.
22.	何禮賢. 肺部感染性疾病. 上海: 上海醫科大學出版社, 1996.
23.	陳灝珠. 實用內科學(下). 北京: 人民衛生出版社, 2001.
24.	王吉耀, 葛均波, 鄒和建等. 實用內科學(第16版·下). 北京: 人民衛生出版社, 2022.
25.	Zhu H, Wang S, Shan C, et al. Mechanism of protective effect of xuan-bai-cheng-qi decoction on LPS-induced acute lung injury based on an integrated network pharmacology and RNA-sequencing approach. Respir Res, 2021, 22(1): 188.
26.	Deng D, Zhao M, Liu H, et al. Xijiao Dihuang decoction combined with Yinqiao powder promotes autophagy-dependent ROS decrease to inhibit ROS/NLRP3/pyroptosis regulation axis in influenza virus infection. Phytomedicine, 2024, 128: 155446.
27.	Liu Z, Gao J, Ban Y, et al. Synergistic effect of paeoniflorin combined with luteolin in alleviating lipopolysaccharides-induced acute lung injury. J Ethnopharmacol, 2024, 327: 118022.
28.	Xu Y, Bao L, Cao S, et al. Pharmacological effects and mechanism of Maxing Shigan decoction in the treatment of pseudomonas aeruginosa pneumonia. J Ethnopharmacol, 2024, 320: 117424.
29.	Chen G, Zhang W, Kong L, et al. Qiguiyin decoction improves multidrug-resistant pseudomonas aeruginosa infection in rats by regulating inflammatory cytokines and the TLR4/MyD88/NF- κ B signaling pathway. Biomed Res Int, 2022: 5066434.
30.	Hou Y, Nie Y, Cheng B, et al. Qingfei Xiaoyan Wan, a traditional Chinese medicine formula, ameliorates pseudomonas aeruginosa-induced acute lung inflammation by regulation of PI3K/AKT and Ras/MAPK pathways. Acta Pharm Sin B, 2016, 6(3): 212-221.
31.	Li X, Wei S, Ma X, et al. Efficacy and safety of Tanreqing injection combined with antibiotics against streptococcus pneumoniae pneumonia: a systematic review and meta-analysis. J Clin Pharm Ther, 2022, 47(8): 1159-1172.
32.	楊江, 李宣霖, 王建新, 等. 疏風解毒膠囊輔助治療成人社區獲得性肺炎有效性和安全性的Meta分析. 中國全科醫學, 2022, 25(23): 2922-2931.
33.	王一民, 呂朗, 范海偉, 等. 喜炎平注射液聯合抗生素治療成人社區獲得性肺炎療效和安全性的Meta分析. 中草藥, 2018, 49(2): 468-476.
34.	管翠萍, 馮磊, 喬霞, 等. 不同中藥提取物對耐甲氧西林金黃色葡萄球菌的抑菌作用和逆轉機制. 中國獸醫學報, 2015, 35(12): 1997-2001.

1. Aliberti S, Dela Cruz CS, Amati F, et al. Community-acquired pneumonia. Lancet, 2021, 398(10303): 906-919.
2. 國家衛生健康委員會統計信息中心. 2022中國衛生健康統計年鑒. 2023.
3. Di Pasquale MF, Sotgiu G, Gramegna A, et al. Prevalence and etiology of community-acquired pneumonia in immunocompromised patients. Clin Infect Dis, 2019, 68(9): 1482-1493.
4. Aliberti S, Reyes LF, Faverio P, et al. Global initiative for meticillin-resistant staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis, 2016, 16(12): 1364-1376.
5. 熊旭東, 錢義明, 陸一鳴, 等. 中西醫聯合治療社區獲得性肺炎專家共識(2014版). 中國中西醫結合急救雜志, 2015, (1): 1-6.
6. 彭明松. 中醫辨證治療老年肺炎的療效觀察. 臨床醫藥文獻電子雜志, 2019, 6(8): 80.
7. 余學慶, 謝洋, 李建生. 社區獲得性肺炎中醫診療指南(2018修訂版). 中醫雜志, 2019, 60(4): 350-360.
8. 王曉錦, 李爭, 李風森. 中藥湯劑治療成人重癥肺炎療效的網狀Meta分析. 海南醫學院學報, 2023, 30(13): 1002-1018.
9. 中華中醫藥學會肺系病分會. 中醫藥單用/聯合抗生素治療社區獲得性肺炎臨床實踐指南. 中日友好醫院學報, 2021, 35(1): 8-11, 15.
10. Xie K, Guan S, Jing H, et al. Efficacy and safety of traditional Chinese medicine adjuvant therapy for severe pneumonia: evidence mapping of the randomized controlled trials, systematic reviews, and meta-analyses. Front Pharmacol, 2023, 14: 1227436.
11. 國鈺妍. 中醫辨證論治與奧司他韋治療流感輕癥的臨床隨機對照研究. 北京: 北京中醫藥大學, 2014.
12. 顏芳, 楊志敏, 徐國峰, 等. 運用經方純中醫治療肺部感染102例. 北京: 國際(中日韓)經方學術會議第二屆全國經方論壇暨經方應用高級研修班, 2011.
13. Su G, Xu Y, Xu X, et al. Association between reduced renal function and cardiovascular mortality in patients hospitalized with infection: a multi-center cohort study. Eur J Intern Med, 2018, 57: 32-38.
14. 中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
15. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003, 58(5): 377-382.
16. 張涌彬, 李若愚, 賴海峰. 瀉肺通腑法治療老年重癥肺炎合并胃腸功能障礙的臨床療效. 內蒙古中醫藥, 2019, 38(10): 129-131.
17. 章昕, 蔡玲, 王秋雁. 痰熱清注射液對呼吸機相關性肺炎患者感染參數和臨床預后的影響. 中國中醫急癥, 2012, 21(8): 1223, 1241.
18. 王知兵, 于克靜, 劉倩倩, 等. 加味宣白承氣湯輔助治療重癥創傷呼吸機相關性肺炎痰熱壅肺證患者30例臨床觀察. 中醫雜志, 2023, 64(3): 269-274.
19. 李得民, 齊蕊涵, 張洪春, 等. 《中醫藥單用/聯合抗生素治療社區獲得性肺炎臨床實踐指南》臨床應用評價與修訂意見. 中國中藥雜志, 2018, 43(24): 4759-4764.
20. 黃維俊. 過用抗生素與中醫寒郁現象. 河北中醫, 2005, (3): 190.
21. 周育平. 李春生教授治療抗生素相關性腹瀉經驗. 中國中醫急癥, 2003, (1): 49.
22. 何禮賢. 肺部感染性疾病. 上海: 上海醫科大學出版社, 1996.
23. 陳灝珠. 實用內科學(下). 北京: 人民衛生出版社, 2001.
24. 王吉耀, 葛均波, 鄒和建等. 實用內科學(第16版·下). 北京: 人民衛生出版社, 2022.
25. Zhu H, Wang S, Shan C, et al. Mechanism of protective effect of xuan-bai-cheng-qi decoction on LPS-induced acute lung injury based on an integrated network pharmacology and RNA-sequencing approach. Respir Res, 2021, 22(1): 188.
26. Deng D, Zhao M, Liu H, et al. Xijiao Dihuang decoction combined with Yinqiao powder promotes autophagy-dependent ROS decrease to inhibit ROS/NLRP3/pyroptosis regulation axis in influenza virus infection. Phytomedicine, 2024, 128: 155446.
27. Liu Z, Gao J, Ban Y, et al. Synergistic effect of paeoniflorin combined with luteolin in alleviating lipopolysaccharides-induced acute lung injury. J Ethnopharmacol, 2024, 327: 118022.
28. Xu Y, Bao L, Cao S, et al. Pharmacological effects and mechanism of Maxing Shigan decoction in the treatment of pseudomonas aeruginosa pneumonia. J Ethnopharmacol, 2024, 320: 117424.
29. Chen G, Zhang W, Kong L, et al. Qiguiyin decoction improves multidrug-resistant pseudomonas aeruginosa infection in rats by regulating inflammatory cytokines and the TLR4/MyD88/NF- κ B signaling pathway. Biomed Res Int, 2022: 5066434.
30. Hou Y, Nie Y, Cheng B, et al. Qingfei Xiaoyan Wan, a traditional Chinese medicine formula, ameliorates pseudomonas aeruginosa-induced acute lung inflammation by regulation of PI3K/AKT and Ras/MAPK pathways. Acta Pharm Sin B, 2016, 6(3): 212-221.
31. Li X, Wei S, Ma X, et al. Efficacy and safety of Tanreqing injection combined with antibiotics against streptococcus pneumoniae pneumonia: a systematic review and meta-analysis. J Clin Pharm Ther, 2022, 47(8): 1159-1172.
32. 楊江, 李宣霖, 王建新, 等. 疏風解毒膠囊輔助治療成人社區獲得性肺炎有效性和安全性的Meta分析. 中國全科醫學, 2022, 25(23): 2922-2931.
33. 王一民, 呂朗, 范海偉, 等. 喜炎平注射液聯合抗生素治療成人社區獲得性肺炎療效和安全性的Meta分析. 中草藥, 2018, 49(2): 468-476.
34. 管翠萍, 馮磊, 喬霞, 等. 不同中藥提取物對耐甲氧西林金黃色葡萄球菌的抑菌作用和逆轉機制. 中國獸醫學報, 2015, 35(12): 1997-2001.

Chinese Journal of Evidence-Based Medicine

Comparative effectiveness research of Chinese medicine and integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia: a retrospective cohort study design

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