陈育群 张鹏飞 黄政德

摘要：目的 基于累積Meta分析方法系统评价甘温除热法治疗气虚型内伤发热的临床疗效。方法 计算机检索中国知识资源总库（CNKI）、中国学术期刊数据库（万方数据）、中国生物医学文献数据库（CBM）、中文科技期刊数据库（VIP）、PubMed、Cochrane Library、Embase建库至2017年4月收录的甘温除热法治疗气虚型内伤发热随机对照试验文献。2名研究者独立进行文献筛选、交叉核对、资料提取和文献质量评价后，对结局指标按发表时间顺序和样本量分别进行累积Meta分析，并对其结果趋势进行检验，然后基于GRADE对文献质量进行整体评价。结果 共纳入27篇文献，涉及受试者2599名。累积Meta分析结果显示，单用甘温除热法[OR=3.875，95%CI（2.87，5.24），Z=8.82，P=0.000 1]或甘温除热法联用常规疗法[OR=5.791，95%CI（3.55，9.45），Z=7.03，P=0.000 1]总有效率均明显优于常规疗法，差异有统计学意义。趋势检验表明，联用药物研究在时间方面存在易变性，显示累积Meta分析结果不稳定。结论 甘温除热法治疗气虚型内伤发热疗效确切，但纳入研究整体质量偏低，同质性较高，发表存在偏倚，尚需更多高质量临床研究验证。

关键词：甘温除热法；气虚；内伤发热：累积Meta分析；系统评价

DOI：10.3969/j.issn.1005-5304.2018.09.024

中图分类号：R2-05；R255.1 文献标识码：A 文章编号：1005-5304（2018）09-0101-06

Abstract： Objective To systematically evaluate the clinical efficacy of relieving fever with sweet and warm drugs （Ganwen Chure Therapy） for noninfectious fever caused by vital-energy deficiency based on Meta-analysis. Methods Literature about RCTs of Ganwen Chure Therapy for noninfectious fever caused by vital-energy deficiency in CNKI， Wanfang Database， CBM， VIP， PubMed， Cochrane Library， and Embase was retrieved by computers from establishment of database to April 2017. After two researchers independently conducted literature screening， cross-checking， data extraction， and literature quality evaluation， cumulative Meta-analysis was performed on the outcome indicators in order of publication time and sample size， and the trend of the results was tested. Then the quality of the literature based on GRADE was under an overall evaluation. Results Totally 27 articles were included in this study， involving 2599 patients. The results of cumulative Meta-analysis showed that the total effective rates of using Ganwen Chure Therapy only [OR=3.875， 95%CI （2.87， 5.24）， Z=8.82， P=0.000 1] and Ganwen Chure Therapy combined with routine therapy [OR=5.791， 95%CI （3.55， 9.45）， Z=7.03， P=0.000 1] were better than the routine therapy， with statistical significance. Trend test showed that there was variability in the timing of drug combination study， showing that the cumulative Meta-analysis results were not stable. Conclusion Ganwen Chure Therapy has certain efficacy for noninfectious fever caused by vital-energy deficiency. However， the overall quality of the included studies was low， with relatively high homogeneity. There are biases in publication， yet more high-quality clinical research is needed for further verification.

Keywords： relieving fever with sweet and warm drugs； qi deficiency； noninfectious fever caused by vital-energy deficiency； cumulative Meta-analysis； systematic evaluation

气虚发热属内伤发热范畴，西医将之归属于非感染性发热。《素问·调经论篇》“有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃气热，热气熏胸中，故内热”，阐述了劳伤脾胃，导致脾胃气虚，水湿运化失常，郁而化热的病机，为气虚发热理论的形成奠定了基础。《金匮要略·血痹虚劳病脉证并治》提出“虚劳里急，悸衄，腹中痛，梦失精，四肢酸疼，手足烦热，咽干口燥，小建中汤主之”，首次提出了甘温除热法治疗阴阳失调所致虚劳病证。……